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Colon  Hygiene 


Colon  Hygiene 


Comprising    New  and    Important  Facts  Con' 
cerning  the  Physiology  of   the  Colon  and  an 
Account  of  Practical  and  Successful  Methods  of 
Combating  Intestinal  Inactivity  and  Toxemia 


J.  H.  KELLOGG,  M.  D.,  LL.D. 

SuS)erintendent  of  the  Battle  Creek  Sanitarium;  Author  of  "Neurasthenia, 

Its  Causes  and  Cure,"  "Rational  Hydrotherapy,"  "The  Art  of 

Massage,"  "Light  Therapeutics,"  etc. 


Twenty-eighth  Thousand 


BATTLE  CREEK,  MICHIGAN 

GOOD  HEALTH  PUBLISHING  CO. 

1917 


Copyright  1917 

BY 

J.  H.  KELLOGG 


K  2.3 


Preface 

That  most  despised  and  neglected  portion  of 
the  body,  the  colon,  has  in  recent  years  been  made 
the  subject  of  much  scientific  study  and  research, 
with  the  result  that  a  lively  controversy  has  been 
stirred  up  over  the  question  as  to  w^hether  this  or- 
gan should  be  permitted  to  remain  a  part  of  the 
"human  form  divine,"  or  w^hether  it  should  be 
cast  out  as  worse  than  useless  and  unworthy  of  a 
place  in  the  anatomy  of  the  modern  genus  homo. 

Anatomists  have  declared  the  colon  to  be  a 
useless  appendage,  a  vestigial  remnant  left  over 
from  a  prehistoric  state.  Bacteriologists  have 
charged  it  with  being  an  incubating  chamber  of 
poison-forming  germs,  a  hold  of  unclean  and  hate- 
ful parasites,  a  veritable  Pandora's  box  of  disease 
and  degeneracy.  Surgeons  have  removed  the  offend- 
ing organ,  and  thus  proved  that  it  may  be  dispensed 
with,  and  have  claimed  wonderful  advantages  from 
this  abbreviation  of  the  prima  vite. 

Barclay  Smith,  the  great  English  anatomist,  first 
suggested  the  uselessness  of  the  colon.  MetchnikoflE 
proved  that  animals  that  possess  the  longest 
colons  have  the  shortest  lives,  and  announced  that 
the  colon  bacillus  is  the  germ  of  old  age.  Sir 
William  Arbuthnot  Lane,  the  eminent  London 
surgeon,  cites  a  long  list  of  grave  maladies,  ranging 


10  PREFACE 

from  tuberculosis  to  rheumatism,  cured  by  removal 
of  this  offending  organ. 

The  war  still  wages.  There  are  pro-colon  par- 
tisans as  well  as  anti-colon  enthusiasts.  One  thing 
is  certain,  however,  the  colon  can  no  longer  be 
ignored.  That  this  organ,  or  rather  the  morbid 
conditions  that  develop  in  it,  plays  a  dominant  role 
in  the  causation  of  a  long  list  of  the  gravest  and 
most  common  disorders,  can  no  longer  be  denied. 

In  the  treatment  of  every  chronic  disease,  and 
most  acute  maladies,  the  colon  must  be  reckoned 
with.  That  the  average  colon,  in  civilized  com- 
munities, is  in  a  desperately  depraved  and  danger- 
ous condition,  can  no  longer  be  doubted.  The 
colon  must  either  be  removed  or  reformed.  From 
the  beginning  of  the  colon  controversy  and  for 
many  years  before,  the  writer  has  been  a  very 
earnest  student  of  the  questions  involved,  and  has 
formed  very  definite  opinions,  the  validity  of 
which  he,  together  with  his  colleagues  of  the  fac- 
ulty of  the  Battle  Creek  Sanitarium,  has  had  oppor- 
tunity to  test  in  the  treatment  of  many  thousands 
of  sufferers  from  colon  and  colon-caused  maladies. 
The  writer  believes  that  methods  have  been  worked 
out  by  means  of  which  the  colon  may  be  reformed 
and  made  to  do  its  work  efficiently,  not  only  in 
ordinary  cases,  but  in  by  far  the  great  majority  of 
those  cases  which  are  thought  by  enthusiastic  colon 
surgeons  to  be  suitable  subjects  for  surgical  treat- 
ment. 


PREFACE  1 1 

Until  very  recent  years  almost  nothing  has  been 
known  of  the  physiology  of  the  colon.  This  part 
of  the  body  has  been  almost  a  terra  incognita.  The 
physiology  of  digestion  stopped  at  the  ileocecal 
valve.  How  the  colon  dealt  with  its  contents,  how 
the  very  necessary  act  of  defecation  was  performed, 
nobody  knew.  The  discovery  of  the  X-ray  en- 
abled Cannon  and,  later,  Hertz  to  study  the  colon 
while  in  action  in  animals  and  man.  Elliot,  Keith, 
and  other  anatomists  studied  the  intestine  in  dogs, 
and  finally  Case,  by  perfecting  the  X-ray  technic 
of  colon  examinations,  completed  the  physiologic 
study  of  this  previously  neglected  organ.  The 
combined  result  of  the  extensive  labors  of  these 
investigators  has  been  a  great  flood  of  light  upon 
some  of  the  most  obscure  questions  in  physiology. 
These  new  facts,  not  yet  known  to  the  general 
public,  have  rendered  the  greatest  service  in  the 
development  of  rational  methods  of  dealing  with 
that  most  common  and  most  destructive  disease  of 
civilized  peoples — constipation.  The  chief  purpose 
of  this  work  is  to  present  in  a  popular  way  these  new 
facts  and  the  practical  results  to  which  they  have 
led. 

Forty  years'  experience  and  observation  in  deal- 
ing with  chronic  invalids,  and  careful  study  of 
the  results  of  the  modern  X-ray  investigations  of 
the  colon,  together  with  observations  made  at  the 
operating  table  in  many  hundreds  of  cases,  has 
convinced  the  writer — 


12  PREFACE 

1.  That  constipation  with  its  consequences  is 
the  result  of  the  unnatural  habits  in  relation  to  diet 
and  colon  hygiene  which  prevail  among  civilized 
people. 

2.  That  patients  are  not  constipated  on  gen- 
eral principles,  but  that  there  exists  in  every  case 
of  constipation  some  particular  condition  which  is 
the  immediate  cause  of  the  delayed  intestinal  move- 
ment, and  which  must  be  removed  before  definite 
relief  can  be  obtained,  and  that  in  the  great  ma- 
jority of  cases  this  cause  is  mechanical  in  character, 
a  fold,  a  kink,  a  redundancy,  a  contraction — in 
short,  some  real  and  tangible  obstruction. 

3.  That  practically  every  case  of  constipation 
is  curable,  and  in  all  but  exceptional  cases  without 
the  aid  of  surgery.  It  must  be  added,  however, 
that  by  cure  is  not  meant  the  working  of  such  a 
miracle  that  the  colon  will  perform  its  function 
normally  without  attention  to  diet  or  other  means 
which  encourage  colon  activity,  but  rather  that  by 
observing  certain  rules  and  the  faithful  and  con- 
tinuous use  of  safe  and  simple  means,  the  colon 
may  be  made  to  perform  its  functions  in  a  regu- 
lar and  efficient  manner,  without  the  use  of 
irritating  laxative  drugs. 

If  some  of  our  recommendations  at  first  impress 
the  reader  unfavorably,  we  ask  only  that  judg- 
ment be  suspended  until  the  suggestion  has  been 
given  a  fair  test  in  actual  experiment.  Every 
measure  presented  has  been  tested  in  the  crucible 


PREFACE  13 

of  actual  experience  in  hundreds  of  cases,  and  is 
the  result  of  a  long  series  of  practical  tests  made 
for  the  purpose  of  determining  the  actual  value  of 
individual  remedies  and  perfecting  practical  methods 
©f  relief. 

If  the  reader  misses  the  usual  list  of  laxative 
drugs,  old  and  new,  the  reason  is  simply  that 
the  writer  regards  all  medicinal  agents  that  force 
bowel  action  by  irritation  (wrongly  termed  "stimu- 
lation") as  pernicious  and,  without  exception,  harm- 
ful, and  to  be  used  only  as  temporary  or  emerg- 
ency measures.  In  the  words  of  the  eminent  Pro- 
fessor Von  Noorden,  "Nothing  is  so  bad  as  the 
chronic  use  of  laxative  drugs." 

The  reader  is  asked  especially  to  note  that  no 
panacea  is  offered  for  colon  miseries;  there  is  no 
"cure  all"  for  constipation.  The  way  out  of  the 
slough  of  intestinal  toxemia  with  its  "biliousness," 
headaches,  neurasthenias,  and  multitudinous  mal- 
adies, is  to  be  found  only  through  living  biolog- 
ically, and  making  use  of  the  "safe  and  sane"  helps 
which  recent  scientific  progress  has  provided. 

In  attempting  to  put  into  semi-popular  form  the 
scientific  facts  pertaining  to  the  hygiene  of  the  colon, 
the  writer  does  not  desire  to  convey  the  impression 
that  the  sufferer  from  severe  constipation  can 
safely  undertake  to  act  as  his  own  physician.  The 
purpose  is  rather  to  enable  the  patient  who  may 
read  this  work  to  cooperate  intelligently  with  the 
wise  up-to-date  physician. 


14  PREFACE 

The  reader's  attention  is  especially  called  to  the 
chapter  on  "The  Bowel  Habits  of  Uncivilized 
Man,"  which  contains  a  fund  of  original  informa- 
tion obtained  at  the  cost  of  much  effort,  w^hich  is 
both  highly  interesting  and  instructive.  The  author 
desires  here  to  acknowledge  his  obligations  to  some 
hundreds  of  medical  colleagues  who  have  devoted 
their  lives  to  the  noble  work  of  carr}ang  to  heathen 
lands  the  blessings  of  modern  scientific  medicine  and 
Christian  civilization,  and  who  have  found  time  in 
the  midst  of  their  arduous  labors  to  answer  the 
questionaire  and  thus  furnished  the  unique  informa- 
tion presented  in  this  chapter. 

PREFACE  TO  FOURTH  EDITION 

REV^ISED  AND  ENLARGED 

The  writer  has  made  a  feAv  important  additions 
in  this  edition  of  "Colon  Hygiene."  The  author 
also  desires  to  express  his  gratitude  for  the  very 
kindly  reception  which  the  book  has  received  and 
the  hope  that  the  revisions  made  in  this  fourth  edi- 
tion will  render  the  volume  still  more  useful  and 
acceptable  to  those  of  the  great  army  of  sufferers 
from  chronic  ailments  into  whose  hands  the  work 
may  fall. 


Contents 

The  Colon 17 

The  Physiology  of  the  Colon 23 

The  Ileocecal  Valve  and  Its  Function     .      .  37 

Normal  Bowel  Action    ...          ...  40 

The  Feces 51 

Influences  Which  Excite  Movements  of  the 

Colon          ., 58 

Influences    Which    Lessen    Intestinal    Move- 
ments      73 

The  Causes  of  Constipation 78 

Habits  Which  give  Rise  to  Constipation       .  87 
Disorders  of  the  Digestive  Tube  .      .      .      .  135 
Alimentary   Toxemia,    or    Intestinal   Autoin- 
toxication      159 

Important  Discussion  of  Alimentary  Toxemia 

before  the  Royal  Society 177 

Forms   of    Constipation 195 

The  Treatment  of  Constipation   ....  201 

Diet   in   Constipation 218 

Baths  and  Other  Home  Treatments  for  Con- 
stipation       241 

Exercises  Which  combat  Constipation     .      .  272 


16  CONTENTS 

Eflficient  Electrical  Methods 300 

Special  Treatment  of  Different  Types  of  Con- 
stipation        303 

Treatment  of  Disorders  Which  Result  from 

Constipation 322 

Bowel  Habits  of  Uncivilized  Man     .      .      .  370 


The  Colon 

Ignoring  technical  anatomical  details  the  food 
canal  may  be  described  as  a  muscular  tube  about 
ten  times  the  length  of  the  body,  measuring  the 
trunk  from  the  top  of  the  head  to  the  end  of  the 
spinal  column.  The  chief  part  is  coiled  up  in  the 
lower  cavity  of  the  trunk,  below  the  diaphragm. 
The  upper  end  of  the  canal  is  controlled  by  the 
circular  muscle  of  the  lips,  which  is  brought  strongly 
into  play  in  whistling.  The  lower  end  is  controlled 
by  the  anus,  also  a  voluntary  circular  muscle.  At 
other  points  along  the  canal,  circular  muscles  are 
placed  to  regulate  the  movements  of  the  foodstuffs 
during  the  process  of  digestion.  Both  in  health  and 
disease  these  "food  gates,"  as  they  may  be  called, 
have  a  most  important  relation  to  digestion  that  has 
not  been  fully  appreciated  until  very  recent  times. 

The  upper  end  of  the  food  tube  is  provided  with 
a  special  apparatus,  the  mouth  and  teeth,  for  taking 
in  food  and  preparing  it  to  undergo  the  various 
processes  which  are  carried  on  in  the  deeper  parts. 
At  the  lower  end  of  the  canal  is  found  a  mechanism 
that  is  wonderfully  designed  to  receive  and  discharge 
from  the  body  the  unused  remnants  of  the  food  and 
other  waste  materials — the  pelvic  colon.  Of  this 
we  shall  learn  more  later.     < 

17 


18  COLON  HYGIENE 

The  Structure  of  the  Food  Tube 

In  structure,  the  food  tube  consists  chiefly  of 
muscle  and  gland  tissue.  There  are  two  sets  of 
muscle  fibres.  One  set,  the  outer,  runs  lengthwise 
of  the  canal;  an  inner,  circular  muscle  structure, 
surrounds  the  canal  throughout  its  entire  length. 

Between  the  muscle  layers  is  a  layer  of  nerve 
cells  and  fibres.  These  are  connected  with  the 
central  nervous  sj^stem,  the  brain  and  spinal  cord, 
but  are  capable  of  acting  independently. 

The  food  canal  is  lined  with  mucous  membrane, 
which  presents  at  various  points  special  groups  of 
glands  that  produce  some  of  the  various  digestive 
juices  which  act  upon  the  food.  The  canal  is  cov- 
ered through  most  of  its  course  with  a  delicate 
membrane,  the  peritoneum. 

The  food  tube  is  roughly  divided  into  six  parts — 
the  mouth,  oesophagus,  stomach,  small  intestine, 
colon  and  rectum.  The  intestine  is  attached  to 
the  spine  by  a  membrane,  the  mesentery,  in  which 
pass  the  nerves  and  blood  vessels  which  supply  the 
canal. 

The  colon  may  roughly  be  described  as  a  mus- 
cular reservoir  about  five  feet  in  length  and  an  inch 
and  a  half  to  three  inches  in  diameter.  This  reser- 
voir is  divided  mto  four  secondary  reservoirs,  the 
cecum,  the  transverse  colon,  the  pelvic  colon,  and 
the  rectum.  The  feces,  in  their  preparation  for 
discharge  from  the  body,  are  passed  successively 
from  one  to  the  other  of  these  reservoirs,  pausing 


a: 


u 


THE  COLON  19 

for  a  definite  interval  in  each,  with  the  exception  of 
the  last. 

Normal  Position  of  the  Colon 

When  in  its  normal  position,  the  colon  begins 
at  the  lower  right  hand  section  of  the  abdominal 
cavity;  its  head,  a  pouch  much  broader  than  the 
rest  of  the  colon,  lies  in  the  hollow  of  the  right 
iliac  bone.  This  is  the  cecum.  The  small  intes- 
tine joins  the  cecum  about  an  inch  and  a  half 
above  its  lower  part,  leaving  a  pocket,  at  the  bottom 
of  which  is  attached  the  appendix. 

From  the  cecum  the  intestine  ascends  along  the 
right  side  of  the  abdomen  to  the  liver.  This  por- 
tion is  the  ascending  colon.  At  the  liver  a  rather 
sharp  turn  is  made  toward  the  left,  the  hepatic 
flexure. 

From  this  point  the  colon  passes  across  the  body 
above  the  umbilicus,  sloping  upward  toward  the 
left  side,  where  it  lies  in  close  contact  with  the 
spleen.     This  section  is  the  transverse  colon. 

At  the  spleen  the  intestine  makes  a  short  turn, 
the  splenic  flexure,  then  passes  downward  along 
the  left  border  of  the  abdominal  cavity  to  the  hip 
bone  (crest  of  the  ileum).  This  is  the  descend- 
ing colon. 

Passing  obliquely  across  the  hollow  surface  of 
the  left  iliac  bone,  the  large  intestine,  here  called 
the  iliac  colon,  reaches  the  upper  border  of  the 
pelvic  cavity.      Here  it   forms  a  loop,   the  pelvic 


20  COLON  HYGIENE 

colon,  which  has  an  average  length  of  a  foot  and 
a  half,  but  which  varies  in  length  from  six  inches 
to  nearly  three  feet  (in  conditions  of  disease).  The 
pelvic  colon  and  iliac  colon  together  form  the  sig- 
moid. The  lower  end  of  the  pelvic  colon  joins 
the  terminal  portion  of  the  intestine,  the  rectum, 
opposite  the  middle  of  the  sacrum.  The  pelvic 
colon  varies  in  position  according  as  it  is  empty  or 
filled.  When  empty,  it  falls  over  backward  into 
the  pelvis,  and  lies  upon  the  upper  part  of  the 
rectum.  When  it  is  in  this  position,  a  very  pro- 
nounced fold  is  formed  at  the  junction  with  the 
rectum,  the  pelvi-rectal  fold,  a  factor  in  con- 
trolling bowel  movements.  Wlien  the  pelvic  loop 
is  full,  it  rises  and  thus  gradually  obliterates  the 
fold  and  so  opens  the  passage  to  the  rectum. 

The  rectum  extends  from  the  pelvi-rectal  fold 
to  the  internal  anal  sphincter,  being  about  six  inches 
in  length.  In  its  upper  part  are  two  or  three 
projecting  folds  of  membrane  known  as  Houston's 
valves. 

The  thicker  muscular  walls  of  the  rectum  are 
ordinarily  contracted  so  that  no  cavity  exists  in 
the  upper  part,  although  some  gas  and  often  (in 
cases  of  disease)  a  considerable  amount  of  fecal 
matter  may  be  found  in  the  lower  part. 

The  distance  between  the  internal  and  external 
sphincter  is  about  one  inch.  This  is  the  anal 
canal,  which  is  ahvays  tightly  closed  except  dur- 
ing defecation. 


Ileocecal   Valve   of   a   Conger   Eel. 
A,   Ileum;    B.    Ileocecal   Valve;    C,   Colon. 


THE  COLON  21 

Just  above  the  internal  anal  sphincter  is  found 
a  series  of  raised  points  or  papillae,  first  described 
by  Horner  of  Philadelphia  many  years  ago.  These 
papillae  are  the  terminal  points  of  special  nerves 
which  when  excited  cause  powerful  contraction  of 
the  colon  and  the  abdominal  muscles  and  dia- 
phragm, and  at  the  same  time  a  complete  relaxation 
of  the  anal  sphincter. 

Here  are  also  a  number  of  shallow  pockets  in 
the  mucous  membrane,  the  follicles  of  Horner, 
v/hose  function  is  to  secrete  a  lubricating  mucus. 
Both  follicles  and  papillse  sometimes  become  in- 
flamed and  a  source  of  pain. 

Behind  the  rectum  are  located  two  muscles 
which  act  an  important  part  in  defecation,  the 
levator  ani  muscles.  In  contracting,  these  muscles 
pull  the  anus  upward  and  compress  the  rectum, 
and  so  squeeze  out  the  last  particles  of  fecal  matter, 
leaving  the  rectum  completely  empty. 

The  small  intestine  is  a  smooth  tube  of  uniform 
size,  but  the  large  intestine  is  sacculated.  By  a 
thickening  of  its  muscular  structures  at  intervals 
shallow  pouches  are  formed  in  its  sides.  Along  the 
outer  surface  of  the  colon  run  thick  bands  of 
muscle  tissue  which  act  in  defecation  like  gathering 
strings.  In  contracting,  these  bands  draw  the  lat- 
eral pouches  together,  so  as  to  empty  them  of  their 
contents.  These  sacs  or  pouches  are  well  shown 
in  the  accompanying  stereoradiogram,  a  rare  view 
of  the  colon. 


22  COLON  HYGIENE 

All  parts  of  the  large  intestine,  including  the 
rectum,  are  supplied  with  two  sets  of  nerves,  one 
of  which  stimulates  its  muscles  to  contract,  while 
the  other  exercises  an  opposite  influence. 

In  the  accompanying  plates  will  be  seen  represen- 
tations of  the  colons  of  different  animals.  It  is 
especially  interesting  to  note  the  close  relation  be- 
twerai  the  form  of  the  colon  and  the  character  of 
the  food  in  various  classes  of  animals.  In  flesh- 
eating  animals  the  colon  is  always  short;  in  Tege- 
table  eaters  it  is  long  as  compared  with  the  body 
length. 


The  Physiology  of  the  Colon 

The  function  of  the  colon  is  largely  that  of 
a  receptacle  for  unusable  and  waste  matters,  a  sort 
of  human  garbage  box.  On  this  account,  perhaps, 
this  part  of  the  food  tube  has  been  habitually  neg- 
lected. It  has  been  regarded  as  of  little  conse- 
quence. But  modern  studies  of  this  part  of  the 
intestine  have  shown  that  by  neglect  this  temporary 
reservoir  of  wastes  may  become  a  veritable  breed- 
ing place  of  miseries  and  maladies  almost  too  num- 
erous to  mention.  So  many  and  so  serious  are  the 
disorders  of  mind  and  body  which  are  now  trace- 
able to  this  part  of  the  food  tube,  that  not  a  few 
eminent  surgeons  have  advocated  and  practiced  the 
actual  removal  of  the  colon  in  cases  of  chronic 
disease  of  various  sorts,  and  in  many  instances  with 
surprisingly  good  results. 

Professor  MetchnikofE,  of  the  Pasteur  Institute, 
Paris,  Dr.  Arbuthnot  Lane,  head  surgeon  of  Guy's 
Hospital,  London,  Dr.  Barclay  Smith,  and  numerous 
other  scientific  men,  eminent  bacteriologists,  physi- 
ologists, anatomists  and  surgeons,  have  even  an- 
nounced the  belief  that  the  colon  is  a  useless  and 
often  dangerous  structure  and  that  it  may  be  advan- 
tageously dispensed  with. 

The  writer  does  not  accept  this  view,  but  holds 
with  Professor  Keith,  the  eminent  English  anatom- 
ist, that  the  evils  attributed  to  the  colon  are  really 

23 


24  COLON  HYGIENE 

due  to  the  adoption  by  man  of  a  dietary  unsuited  to 
his  anatomy.  All  vegetable-eating  animals  have 
long  colons,  as  has  man.  The  presumption  is  that  a 
vegetable  diet  requires  a  long  colon.  Meat-eating 
animals,  as  the  dog,  have  short  colons.  The  frog 
while  in  the  tadpole  state  is  a  vegetable  feeder  and 
has  a  very  long  colon.  The  adult  frog  feeds  upon 
flesh  and  has  a  very  short  colon. 

The  Wrong  Use  to  Which  We  Put  the  Colon 

The  trouble  with  the  civilized  colon  is  not  that 
it  is  too  long,  but  that  it  is  put  to  a  wrong  use. 
Civilized  man  has  adopted  the  dog's  diet  vvhile 
having  the  colon  of  the  chimpanzee.  It  may  be  ad- 
mitted that  if  a  man  is  to  feed  on  the  diet  of  the  dog 
he  ought  to  have  his  colon  abbreviated.  This  is,  in 
fact,  the  only  way  in  which  he  could  avoid  a  dan- 
gerous biologic  misfit. 

It  is  hardly  to  be  supposed,  however,  that  Nature 
has  made  so  grave  an  error  as  to  give  to  man  an 
organ  which  is  not  only  a  useless  appendage,  but 
at  the  same  time  a  prolific  source  of  mischief.  It 
seems  more  rational  to  believe  that  if  the  colon, 
an  organ  useful  under  normal  conditions  of  life,  is 
found  to  be  so  great  a  source  of  mischief  in  our 
civilized  life,  it  is  because  of  abnormal  and  pernic- 
ious habits  or  other  influences  connected  with  the 
life  of  the  average  civilized  man. 

The  remedy  is  to  be  sought  then,  not  in  the 


Diagram  Showing  Normal  Colon  and 
Ileocecal    Valve 


THE  PHYSIOLOGY  OF  THE  COLON  25 

extirpation  of  a  portion  of  the  body,  but  in  a  cor- 
rection of  those  habits  of  life  in  which  there  has 
been  a  departure  from  the  condition  normal  to 
the  human  species,  and  a  return  to  practices  and 
conditions  which  are  physiologically  and  biolog- 
ically correct  for  the  genus  homo. 

The  First  Function  of  the  Colon 

One  important  function  of  the  colon  is  to  re- 
ceive and  to  discharge  from  the  body  the  unusable 
residue  of  foodstuffs.  If  these  foodstuffs  are  of 
such  a  nature  that  they  readily  undergo  putrefac- 
tion, as  do  meats  of  all  sorts,  the  colon  contents 
will  become  highly  putrescent,  offensive  and  poison- 
ous, while  still  in  the  body.  A  non-putrefying 
vegetable  diet  on  the  other  hand  furnishes  a  residue 
which  cannot  putrefy,  but  ferments,  forming  harm- 
less acids  which  aid  bowel  action.  Hence  the  colon 
is  not  out-of-date,  as  its  critics  have  suggested,  but 
is  only  made  to  appear  as  a  misfit  by  the  adoption  of 
a  diet  which  belongs  to  short-colon  animals.  This 
view  maintained  for  many  years  by  all  advocates  of 
the  biologic  diet  is  so  eminently  reasonable  that  it 
csnnot  fail  to  be  accorded  due  recognition  since  it  is 
now  supported  by  so  eminent  an  authority  as  the 
world-famous  anatomist,  Professor  Keith,  of  Eng- 
land. 

Another  important  function  of  the  alimentary 
canal,  one  which  is  quite  distinct  from  its  function 


26  COLON  HYGIENE 

as  a  digestive  apparatus,  is  its  excretory  function. 
The  intestine  is  the  outlet  of  the  bile,  from  fifteen 
to  twenty  ounces  being  poured  into  the  upper  end 
of  the  small  intestine  every  twenty-four  hours.  The 
bile  is  the  most  poisonous  of  all  the  bodily  secretions, 
being,  according  to  Bouchard,  six  times  as  poisonous 
as  urine.  It  is  through  the  bile  that  the  body  rids' 
itself  of  alkaline  wastes,  some  of  which  are  highly 
poisonous  in  character. 

Another  fact  of  very  great  importance  is  that  the 
intestine  is  itself  an  excretory  organ.  Certain  poi- 
sons are  excreted  by  the  stomach,  others  find  their 
way  out  of  the  blood  through  the  walls  of  the  gall- 
bladder and  the  small  intestines. 

The  colon  forms  a  receptacle  for  all  these  waste 
and  excretory  substances,  together  with  the  un- 
usable or  undigested  residues  of  the  food.  But 
the  collection  of  these  waste  matters  is  only  an 
incidental  function  of  the  colon,  its  really  important 
function  being  to  conduct  these  waste  and  unusable 
matters  out  of  the  body. 

The  food  normally  enters  the  first  part  of  the 
colon,  or  the  cecum,  in  a  nearly  fluid  state,  its 
composition  being  ninety  per  cent  water,  and  only 
one-tenth  solid  matter.  During  the  passage  of 
the  foodstuffs  through  the  twenty-two  feet  of  small 
intestine,  the  digestible  starches,  fats,  and  proteins 
are  rendered  soluble  by  the  digestive  fluids,  and  are 
practically  completely  absorbed.  The  solid  parts 
left  consist  almost  entirely  of  indigestible  remnants 


u 


THE  PHYSIOLOGY  OF  THE  COLON  27 

of  foods,  waste  products  excreted  by  the  liver  and 
the  intestinal  mucous  membrane  and  microbes  which 
are  produced  in  great  numbers  in  the  lower  part 
of  the  small  intestine  as  well  as  in  the  colon. 
The  small  intestine  is  not  only  the  seat  of  the 
principal  digestive  processes,  but  is  also  the  prin- 
cipal organ  of  absorption  of  the  digested  foodstuffs. 
The  colon  normally  absorbs  only  about  one-sixth  of 
the  water  which  remains  in  the  material  received 
from  the  small  intestine,  the  amount  of  which  is 
estimated  at  about  half  a  pint,  and  practically  none 
of  the  foodstuffs.  The  small  intestine  absorbs  daily 
five  or  six  quarts  of  liquids  and  all  the  products  of 
digestion.  It  is,  in  fact,  the  one  great  avenue  for 
the  intake  of  nutrients,  both  solid  and  liquid. 

About  four  hours  after  a  meal,  bubbling  and 
squirting  sounds  may  be  distinctly  heard  when  the 
ear  is  placed  over  the  right  lower  abdomen,  and  an 
hour  or  two  later  it  is  easy  to  produce  splashing 
and  gurgling  sounds  by  intermittent  pressure  over 
the  colon  low  down  in  the  right  side  of  the  abdo- 
men, showing  that  a  considerable  amount  of  fluid 
has  passed  from  the  small  intestine  into  the  cecum. 
It  should  be  remembered  that  this  is  not  a  mere 
mechanical  process.  The  fluid  food  does  not  pass  by 
gravity  from  the  small  bowel  into  the  large  intestine 
as  water  might  trickle  from  a  pipe  into  a  reservoir. 
The  opening  of  the  small  intestine  into  the  colon  is 
controlled  by  a  sphincter,  the  ileocecal  valve.  This 
circular  muscle  holds  the  food  in  check  in  the  lower 


28  COLON  HYGIENE 

part  of  the  small  intestine  long  enough  to  make 
sure  that  digestion  is  complete  and  the  absorption 
of  digested  foodstujffs  practically  finished.  In  other 
words,  the  ileocecal  valve  is  a  sort  of  second  pylorus, 
and  serves  much  the  same  purpose. 

The  pylorus  and  ileocecal  gates  hold  back  solid 
and  imperfectly  digested  foodstuffs,  permitting  the 
fluid  portion  to  pass  on.  In  the  cecum  and  ascend- 
ing colon  the  food  is  detained  by  a  special  process,  so 
that  its  fluid  portion  may  be  absorbed,  thus  increas- 
ing the  consistency  of  the  bowel  contents.  Gradu- 
ally a  portion  of  the  water  is  taken  up  by  the  absorb- 
ents, which  are  very  numerous  in  this  part  of  the 
colon,  and  at  the  same  time  the  more  solid  portions 
are  pushed  along  toward  the  upper  end  of  the  as- 
cending colon,  the  fluid  part  dropping  back  into  the 
cecal  pouch  for  absorption. 

Keith,  the  eminent  English  anatomist,  has  re- 
cently pointed  out  new  facts  of  great  interest  in  re- 
lation to  the  control  of  the  movements  of  the  ali- 
mentary canal.  Keith  has  shown  that  the  muscular 
structures  of  the  intestine  have  the  same  property 
of  rhythmic  action  as  is  possessed  by  the  muscle 
fibres  of  the  heart.  This  tendency  to  rhythmic 
movement  of  the  individual  fibres  is  an  organized, 
orderly  action  of  certain  centers  or  nodes  which  are 
designated  as  pace  makers.  These  nodes  have  been 
shown  to  exist  at  the  following  points  along  the 
alimentary  canal — the  upper  or  cardiac  orifice  of 
the  stomach,  the  pylorus,  the  duodenum,  the  ileo- 


u 


o 


s 

V 


U 


u 


THE  PHYSIOLOGY  OF  THE  COLON  29 

cecal  valve,  the  transverse  colon,  the  junction  of  the 
pelvic  colon,  the  rectum  and  the  internal  anal 
sphincter. 

Movements  of  the  Colon 

Like  the  stomach,  the  colon  has  movements  pC' 
culiar  to  itself, — four  very  distinct  modes  of  con- 
traction.   These  are: 

1.  Molding  movements,  by  which  the  contents 
are  slowly  compressed  and  molded.  These  move- 
ments are  almost  too  slow  to  be  noticed  by  the 
eye  in  X-Ray  examinations  except  by  observations 
made  at  intervals  of  a  half  hour  or  more. 

2.  Propulsive  movements,  by  which  the  colon 
contents  are  passed  along  so  rapidly  that  the  eye 
cannot  follow  the  movement.  Movements  of  this 
sort  occur  regiilarly  v/hen  the  bowels  are  evacuated 
and  also  at  other  times. 

3.  Snake-like  movements.  Roeder,  of  Germany, 
has  recently  described  movements  in  which  the 
transverse  or  free  part  of  the  colon  moves  about 
in  a  manner  closely  resembling  the  contortions  of  a 
serpent.  From  this  he  concludes  that  the  position 
of  the  transverse  colon,  unless  it  is  held  fast  by 
adhesions,  is  not  a  definite  one  and  is  not  a  matter 
of  much  importance. 

4.  Reverse  Peristalsis.  Anti-peristalsis,  that  is, 
a  reverse  movement  of  the  intestine,  was  first 
observed  by  Jacobi,  more  than  twenty  years  ago, 
and  has  more  recently  been  studied  in  cats  by  Can- 


30  COLON  HYGIENE 

non.  These  movements  occur  systematically  while 
the  contents  of  the  cecum  are  fluid  in  character,  and 
serve  both  to  prevent  the  sudden  and  frequent  dis- 
charge of  the  bowel  contents,  as  in  diarrhoea,  and 
also  to  churn  the  contents  of  the  cecum,  thus  bring- 
ing every  portion  in  contact  with  the  walls  of  the 
gut,  so  that  absorption  may  be  assisted. 

As  studied  in  animals,  by  Cannon,  and  in  human 
beings  by  Case,  the  rhythmical  reverse  movements 
which  occur  in  the  colon,  never  in  the  small  intes- 
tine, are  interrupted  at  regular  intervals  by  a  down- 
ward peristalsis.  These  downward  movements 
occur  at  intervals  of  about  fifteen  seconds. 

The  tight  closure  of  the  ileocecal  valve  alone 
prevents  the  contents  of  the  cecum  from  being 
forced  by  these  powerful  anti-peristaltic  waves 
backward  into  the  small  intestine.  At  intervals  the 
anti-peristaltic  waves  cease  momentarily,  while  the 
ileocecal  valve  relaxes,  and  small  portions  of  material 
are  passed  into  the  cecum  from  the  small  intestine; 
then  the  anti-peristaltic  waves  again  begin,  churn- 
ing the  liquid  material,  spreading  it  over  the  sur- 
face of  the  cecum  and  ascending  colon,  thus  encour- 
aging absorption,  while  at  the  same  time  exerting 
a  pumping  action  upon  the  venous  and  l5Tiiphatic 
vessels,  so  that  the  contents  of  the  cecum  are  rapidly 
dried  down  to  the  proper  consistency. 

It  is  very  probable  that  the  common  practice  of 
resisting  the  "call"  of  Nature  for  evacuation,  may 
have  produced  abnormal  conditions  of   the  colon. 


THE  PHYSIOLOGY  OF  THE  COLON  31 

by  which  its  normal  functions  are  obscured  to  a  very 
considerable  degree.  The  theory  of  anti-peristalsis, 
first  suggested  by  O'Bierne,  accords  well  with  the 
facts  of  clinical  experience,  and  may  now  be  recog- 
nized as  a  fully  established  fact,  especially  since 
anti-peristalsis  has  been  actually  observed  in  man 
by  Case  on  numerous  occasions,  in  the  X-ray  de- 
partment of  the  Battle  Creek  Sanitarium. 

The  Pelvic  Colon 

The  pelvic  loop  of  the  colon,  which,  with  the 
Iliac  colon  forms  what  was  formerly  known  as  the 
sigmoid  flexure,  constitutes  the  motive  part  of  the 
mechanism  by  means  of  which  the  feces  are  dis- 
charged from  the  body.  This  loop  of  intestine, 
when  empty,  lies  low  down  In  the  pelvis,  the  lower 
end  of  the  loop  where  it  joins  the  rectum  being 
closed  by  a  sharp  fold.  There  may  be  a  sphincter 
at  this  point,  although  not  in  a  state  of  constant 
contraction.  The  loop  fills  from  below  as  fecal 
matters  gradually  and  slowly  enter  it  from  above. 
As  It  fills,  the  loop  gradually  rises,  finally  reaching  a 
point  at  which  the  valve  opens,  so  that  the  feces 
can  enter  the  rectum.  As  the  rectum  walls  become 
distended  by  the  accumulation  of  feces,  the  defecat- 
ing center  is  stimulated;  and  powerful  nerve  im- 
pulses are  sent  out,  which  cause  the  pelvic  loop  to 
contract,  thus  compressing  Its  contents  just  as  one 
compresses  the  contents  of  a  rubber  bulb  by  squeez- 
ing it  with  the  hand.    The  contraction  of  the  pelvic 


32  COLON  HYGIENE 

loop  is  normally  so  vigorous  and  complete  that  it  is 
fully  emptied  of  its  contents.  The  contraction  of 
the  descending  colon  at  the  same  time  is  normally 
sufficiently  strong  to  carry  the  contents  of  the  des- 
cending and  iliac  colon  into  and  through  the  pelvic 
loop,  so  that  the  left  half  of  the  colon,  from  the 
splenic  flexure  to  the  anus  is  emptied  in  normal 
defecation.  At  the  end  of  the  contraction,  the  pelvic 
loop,  or  at  least  the  mucous  lining  of  the  loop  at  its 
lower  end,  may  be  pushed  dovi^n  into  the  rectum 
like  a  piston,  thus  ensuring  complete  emptying  of 
the  rectum.  The  action  of  the  pelvic  colon  thus 
resembles  that  of  a  bulb  and  piston  combined,  the 
upper  part  acting  like  a  compressing  bulb,  while  the 
lower  part  serves  as  a  piston,  thus  forming  a  sur- 
prisingly effective  mechanism  for  discharging  the 
body  wastes. 

'  Careful  and  long-continued  observations  of  the 
time  required  for  the  passage  of  food  through  the 
different  sections  of  the  alimentary  canal,  have  se- 
cured very  definite  and  exact  information  upon  this 
very  important  subject,  on  which  are  based  the  fig- 
ures given  below. 

The  following  table  shows,  according  to  Rosen- 
heim, the  time  required  for  the  food  to  reach  the 
more  important  of  the  stations  along  the  alimen- 
tary tube,  reckoning  from  the  time  the  food  is 
eaten,  since  it  is  known  that  food  begins  to  pass 
out  of  the  pylorus  very  soon  after  the  beginning 
of  a  meal: 


THE  PHYSIOLOGY  OF  THE  COLON  33 

The  Digestive  Time  Table 

Cecum     4  hrs. 

Hepatic  flexure  6  hrs. 

Splenic    flexure    8  hrs. 

Iliac  colon  9  hrs. 

Pelvic  colon    10  hrs. 

Rectum    16  hrs. 

Discharge  of   residues 18  hrs. 

The  X-ray  shows  that  food  often  reaches  the 
ileocecal  valve  within  half  an  hour  after  it  is  taken 
into  the  mouth.  It  does  not  pass  into  the  colon  at 
once,  However,  but  accumulates  in  the  lowest  coils 
of  the  ileum,  which  finally  becomes  distended  to 
such  a  degree  that  segmentation  is  set  up,  and  by 
this  means  the  food  is  pushed  forward  into  the 
cecum. 

The  last  of  the  food  taken  into  the  stomach 
does  not  reach  the  colon  until  the  end  of  about  nine 
hours  from  the  time  it  is  eaten.  Thus,  the  entire 
meal  should  reach  the  pelvic  colon,  according  to 
Rosenheim,  at  the  end  of  about  fourteen  hours. 

The  delay  of  six  hours  in  the  pelvic  colon  seems 
wholly  unreasonable  and  unnecessary.  If  the  food 
can  pass  from  the  splenic  flexure  to  the  pelvic  colon 
in  two  hours  (Rosenheim)  it  would  seem  that  it 
ought  to  be  able  to  traverse  the  short  pelvic  loop 
in  the  same  length  of  time,  or  less.  The  processes  of 
digestion  and  absorption  of  digested  products  is 
completed  before  the  splenic  flexure  is  reached.   The 


34  COLON  HYGIENE 

descending  colon,  iliac  and  pelvic  '^o'"".  ;'f  *=^ 
rectum,  contain  few  absorbent  vessels.     The  teces 
are  ready  for  discharge  from  the  body;  what  pos- 
Me  benefit  can  result  from  their  longer  retennon? 
Putrefaction  processes  are  actively  at  work  produc- 
ing ptomaines  and  other  toxms  m  1"™''^-     5 
absorption,  these  may  become  a  source  of  enormous 
and  irreparable  mischief.    Why  should  not  the  un- 
usable   food   remnants,    the  wastes   and  m-crobe 
which  constitute  the  fecal  mass,  be  gotte"  "d  o 
as  soon  as  possible  when  prepared  for  exit?     Is  it 
L  more  than  probable  that  the  lower  part  of  the 
human  intestine,   which  is  most  subject  to  the  m- 
tonce  of  voluntary  interference,  has  been  so  long 
abu"ed,  discouraged  and  hindered  that  tt  has  become 
abnormally  slow  and  dilatory? 

Evacuation  of  the  Colon 

The  evacuation  of  the  bowels  \  ^'^"'"P^'fl^^J 
by  means  of  seven  distinct  actions,  three  of  which 
are  voluntary  and  four  automatic.  Arranged  in 
Z  Irder  o7  natural  sequence,  the  following  are 
Z  "veral  acts  which  together  constitute  normal 
bowel  movement. 

1      Descent  of  the  diaphragm  and  compre^ion 
of    'the    bowels,     accomplished  by   taking   a   deep 

^T    Voluntary    contraction    of    the    abdominal 
muscles,  increasing  the  compression. 


THE  PHYSIOLOGY  OF  THE  COLON         35 

3.  Pressure  of  the  thighs  against  the  abdominal 
wall  (natural  position  in  moving  the  bowels  is 
not  the  upright  sitting  position,  but  a  crouching 
or  squatting  position  universally  employed  by 
savages  and  in  some  pioneer  rural  communities). 

The  result  of  these  three  voluntary  efforts  is  to 
force  a  portion  of  the  contents  of  the  pelvic  colon 
into  the  rectum,  the  distention  of  which  gives  rise 
to  stimulation  of  the  defecation  center  of  the  sym- 
pathetic nervous  system  by  means  of  which  the  four 
automatic  movements  in  defecation  are  brought  into 
action,  consisting  of  the  following: 

4.  Reflex  contraction  of  the  abdominal  muscles, 
reinforcing  the  voluntary  contraction. 

5.  Contraction  of  the  colon ;  the  descending  and 
pelvic  colons  are  chiefly  active,  though  sometimes 
the  whole  colon  contracts. 

6.  Reflex  relaxation  of  the  anal  sphincter,  in 
obedience  to  the  general  law  which  holds  through- 
out the  entire  digestive  tube,  by  virtue  of  which 
a  wave  of  contraction  passing  along  any  portion  of 
the  canal  is  immediately  preceded  by  a  wave  of 
relaxation. 

7.  Contraction  of  the  levator  ani,  a  structure 
which  surrounds  the  rectum  and  contracts  at  the 
end  of  defecation  for  the  purpose  of  forcing  out 
the  last  remnants  of  fecal  matter,  so  that  the  rec- 
tum may  remain  empty  until  another  movement 
occurs. 


36  COLON  HYGIENE 

There  are  really  eight  steps  in  the  defecation; 
process,  if  we  include  the  preliminary  filling  of 
the  pelvic  colon  with  fecal  matter.  A  disturbance 
of  any  one  of  these  eight  factors  in  the  process 
of  defecation  may  result  in  constipation.  If  the 
diaphragm  contracts  insufficiently  because  of  weak- 
ness, tight  lacing,  adhesions  or  any  other  cause,  or 
if  the  abdominal  muscles  are  weak,  as  is  generally 
the  case  among  civilized  people,  and  if  the  position 
assumed  in  evacuating  the  bowels  is  such  that  the 
abdominal  walls  are  not  compressed  by  the  thighs, 
the  result  may  be  that  the  rectum  is  not  filled  suffi- 
ciently to  stimulate  the  defecation  center,  and  so 
the  reflex  necessary  to  set  in  operation  the  automatic 
movements  which  empty  the  bowel,  will  not  be  pro- 
duced. 

To  be  effective,  the  distention  of  the  rectum 
must  be  complete,  and  must  be  accomplished 
quickly.  If  the  rectum  is  allowed  to  fill  grad- 
ually, stimulation  may  not  occur.  If,  on  the  other 
hand,  distention  of  the  rectum,  as  evidenced  by  a 
desire  to  move  the  bowels,  is  not  relieved  by  going 
to  stool,  the  desire  for  movement  gradually  dis- 
appears through  the  loss  of  sensibility  of  the  rec- 
tal nerves,  and  the  reflex  is  lost.  The  nerves  which 
preside  over  reflex  activities  are  easily  exhausted 
by  continued  stimulation.  Human  physiology  af- 
fords many  examples  of  this  principle. 


The   Ileocecal  Valve   and   Its 
Function 

This  is  an  extremely  interesting  and  important 
anatomical  structure,  which,  though  known  to 
science  for  three  hundred  and  fifty  years,  has  re- 
ceived almost  no  attention  until  very  recently.  The 
ileocecal  valve  was  discovered  by  Servius  in  1563, 
A.  D.  It  has  been  described  by  numerous  anatomists, 
but  was  until  recently  regarded  rather  as  an  ana- 
tomical curiosity  with  no  very  important  function. 

The  ileocecal  valve  consists  of  two  parts  —  a 
sphincter  muscle  and  a  two-lipped  check  valve. 
The  sphincter  is  formed  by  a  thickening  of 
the  circular  muscular  fibres  of  the  small  intestine 
at  its  junction  with  the  colon.  The  check  valve  is 
formed  by  an  invagination  of  the  small  intestine 
into  the  colon.  Something  of  an  idea  of  the  struc- 
ture of  the  valve  may  be  formed  from  the  illustra- 
tion opposite  page  142. 

Action  of  the  Ileocecal  Sphincter 

*"Recent  observations  of  Cannon  have  clearly 
demonstrated  that  the  ileocecal  sphincter  acts  in 
a  manner  very  similar  to  the  pylorus,  retaining  the 
foodstuffs  in  the  small  intestine  until  the  digestive 

*The  paragraphs  in  quotation  marks  are  extracts  from  a  paper 
by  the  author  entitled,  "Incompetency  of  the  Ileocecal  valve." 

37 


38  COLON  HYGIENE 

work  of  the  mid-gut  is  complete  and  the ,  digested 
foodstuffs  have  been  absorbed. 

"Within  the  last  few  years  Holzknecht, 
Schwartz,  Groedel,  Case,  and  numerous  other 
roentgenologists  have  clearly  demonstrated  the 
functional  activity  of  the  ileocecal  valve  in  control- 
ling the  movements  of  foodstuffs  from  the  small 
intestine  into  the  colon.  These  observations  estab- 
lish the  necessity  of  the  ileocecal  valve  for  the  fol- 
lowing purposes : 

"1.  To  hold  back  the  digesting  material  in  the 
small  intestine  until  the  digested  portion  has  been 
transformed  by  the  several  digestive  juices,  and  ab- 
sorbed. 

"2.  To  pass  the  mixture  of  unusable  food  resi- 
due, mucous,  bile,  and  other  excretions  from  the 
small  intestine  into  the  colon  in  small  successive 
doses,  so  as  to  give  the  colon,  the  chief  function  of 
which  is  the  absorption  of  water  and  the  discharge 
of  unusable  food  residues  and  excreta,  an  opportun- 
ity to  deal  with  the  successive  portions  of  material 
brought  to  it  without  being  over-loaded. 

"3.  To  prevent  a  reflux  of  material  from  the 
colon  into  the  small  intestine,  which  is  accomplished 
by  co-operation  of  the  muscular  sphincter  of  the 
proximal  side,  and  the  mechanical  action  of  the 
membranous  folds  on  the  distal  side  of  the  ileocolic 
junction.  The  importance  of  this  function  of  the 
ileocecal  valve  is  greatly  emphasized  by  the  demon- 
stration, by  Cannon,  Schwartz,  Case,  and  others,  of 


THE  ILEOCECAL  VALVE  AND  ITS  FUNCTION    39 

the  existence  of  an  anti-peristaltic  action  in  the 
proximal  half  of  the  colon.  Cannon  gives  a  most 
graphic  description  of  very  powerful  anti-peristaltic 
waves  (as  seen  in  the  cat)  beginning  at  about  the 
middle  of  the  transverse  colon  and  passing  rapidly 
backward  along  the  colon  to  the  cecum,  compress- 
ing the  liquid  contents  of  the  cecum  so  strongly  as 
to  cause  a  backward  rush  through  the  advancing 
ring  of  constriction.  Case  has  confirmed  these»  ob- 
servations in  the  human  subject  in  many  cases." 


Normal  Bowel  Action 

There  is  perhaps  no  important  bodily  function 
so  much  neglected,  and  with  such  damaging  results, 
as  defecation  or  bowel  movement.  This  function  is 
too  often  looked  upon  as  a  humiliating  act  that 
must  be  secreted  and  avoided  whenever  possible, 
and  that  may  properly  be  postponed  to  suit  the 
exigencies  of  business  or  pleasure.  The  "call"  of 
Nature  for  evacuation  of  the  bowels  is  habitually 
ignored  or  resisted  by  children  and  adults  alike, 
until  it  can  no  longer  be  suppressed,  or  until  it 
disappears. 

This  wrong  attitude  toward  one  of  the  most 
important  functions  of  the  body  is  in  large  part 
responsible  for  the  almost  universal  existence  of 
constipation  among  civilized  people,  and  of  wide- 
spread and  most  appalling  evil  consequences,  as  we 
shall  make  clear  in  a  subsequent  chapter. 

Ignorance  of  physiology,  and  especially  of  the 
physiology  of  digestion  and  nutrition,  is  doubtless 
the  cause  of  this  widespread  evil.  It  is  the  duty  of 
every  physician  and  every  trained  nurse  to  do  all 
possible  toward  the  enlightenment  of  the  chronically 
sick  with  whom  they  come  in  contact  in  relation  to 
the  absolute  necessity  for  frequent  and  complete 
bowel  action. 

This  is  a  subject  which  is  too  commonly  tabooed 
by  a  false  modesty  that  is  entirely  out  of  place. 

40 


NORMAL  BOWEL,  ACTION  41 

Mothers  and  school  teachers  especially  should  give 
the  matter  special  consideration.  They  should  make 
sure  that  each  child  under  their  supervision  has 
formed  and  maintains  correct  and  regular  habits 
in  relation  to  evacuation  of  the  bowels. 

The  Mechanism  of  Defecation 

Until  very  recent  times  the  process  by  which 
the  colon  discharges  its  contents  was  one  of  the 
most  obscure  in  physiology.  The  discovery  of  the 
X-ray  and  of  a  method  of  examination  by  which 
the  contents  of  the  stomach  and  intestines  could  be 
made  to  cast  a  shadow  on  the  fluorescent  screen 
or  upon  a  photographic  plate,  has  thrown  a  flood 
of  light  upon  this  extremely  interesting  and  prac- 
tical question. 

As  already  remarked,  the  process  of  defecation 
involves  seven  distinct  acts.  Three  of  these  are 
under  voluntary  control,  the  other  four  being  con- 
trolled by  a  special  center  known  as  the  "center 
of  defecation,"  located  at  the  extreme  lower  end  of 
the  spinal  cord.    , 

The  act  of  defecation  Is  called  forth  by  a  sensa- 
tion of  fulness  in  the  lower  part  of  the  colon.  In 
a  state  of  health  we  ordinarily  perceive  sensation 
only  near  the  extremities  of  the  alimentary  canal. 
At  the  upper  end  of  the  food  tube,  guarding 
the  entrance  to  the  esophagus,  there  is  located  a 
reflex  that  controls  the  intake  of  food  and  liquids. 


42  COLON  HYGIENE 

There  are  nerves  in  the  mucous  membrane  at  the 
back  of  the  throat  that,  when  stimulated  by  the  con- 
tact of  foods  or  liquids,  give  rise  to  the  swallowing 
movement  in  which  the  esophagus  opens  and  food 
or  liquid  present  in  the  throat  is  drawn  in  by  a 
strong  suction  movement.  The  act  of  swallowing  is 
impossible  without  the  contact  of  something  that 
may  be  swallowed. 

At  the  other  end  of  the  food  tube,  within  a  few 
inches  of  the  anus — that  is,  at  the  upper  part  of 
the  rectum — are  found  nerves  that,  when  stimulated 
by  the  contact  of  fecal  matters,  give  rise  to  a  pe- 
culiar sensation  recognized  as  a  warning  that  the 
bowel  contents  should  be  discharged  from  the  body. 

The  "Call" 

Natural  bowel  movement  is  preceded  by  sensa- 
tions which  clearly  indicate  the  necessity  for  evacu- 
ation of  the  bowels.  The  mechanism  of  this  instinct- 
ive notification  of  the  necessity  for  giving  atten- 
tion to  the  needs  of  the  body  is  very  interesting. 
We  have  already  learned  that  the  colon  is  sub- 
divided into  four  separate  compartments  and  that 
the  feces  are  dealt  with  by  each  of  these  in  succes- 
sion. In  the  cecum  the  consistency  of  the  feces  is 
increased  to  such  a  degree  that  the  mass  can  be 
handled  by  the  muscular  wall  of  the  bowel.  The 
ascending  colon  pushes  the  feces  through  the  hepatic 
flexure  into  the  transverse  colon.     In  this  horizon- 


NORMAL  BOWEL  ACTION  4i 

tal  portion  of  the  canal  the  feces  rest  for  a  time 
for  further  extraction  of  water.  From  the  trans- 
verse colon  the  feces  are  pushed  up  the  incline 
to  the  splenic  flexure,  and  through  this  narrow 
gateway  into  the  descending  colon,  along  which,  in 
the  course  of  an  hour  or  two,  it  finds  its  way  to 
the  capacious  loop  of  the  pelvic  colon,  through 
which  it  passes  quickly  to  the  lower  end.  Here  its 
further  progress  is  arrested  by  the  tightly  folded 
canal,  just  as  a  current  of  water  through  a  rubber 
tube  may  be  controlled  by  a  sharp  bend  in  the  tube. 

The  pelvic  loop  gradually  fills,  and  in  filling 
is  raised  until  the  bowel  is  unfolded  and  thus 
opened.  Now,  unless  the  feces  have  been  so  long 
retained  that  they  have  become  hard  and  dry,  the 
bowel  contents  are  pushed  on  into  the  rectum. 

Up  to  this  point  the  progress  of  the  food  material 
after  leaving  the  mouth,  during  its  passage  through 
the  long  food  canal,  has  been  unattended  by  any 
sensation  whatever.  The  process  has  been  wholly 
automatic,  and,  though  controlled  in  a  way  show-  / 
ing  marvelous  intelligence,  wholly  independent  of 
the  consciousness.  But  now  there  is  felt  an  un- 
pleasant sense  of  weight  in  the  region  of  the  rectum.  ,X 
This  sensation  increases  as  the  rectum  becomes 
fuller,  and  there  is  a  more  or  less  urgent  desire  to 
evacuate  the  bowels. 

This  is  the  "call"  of  Nature  for  bowel  move- 
ment, evoked  by  the  contact  of  the  feces  with  the 
nerves  of  the  rectum  and  distention  of  its  walls. 


44  COLON  HYGIENE 

The  fuller  the  rectum  becomes,  the  more  pressing 
is  the  desire  for  evacuation.  The  "call"  appears 
only  when  the  feces  have  reached  the  rectum. 

It  w^ill  now  be  easily  seen  how  the  "call"  and 
the  bowel  movement  may  be  directly  influenced  by 
numerous  factors.  Let  us  briefly  notice  some  of  the 
most  important  of  these,  which  will  be  discussed 
more  fully  in  a  later  chapter. 

If  the  food  taken  is  insufficient  in  bulk,  the 
pelvic  loop  will  be  only  partly  filled,  and  hence 
will  not  rise  high  enough  to  permit  the  feces  to  pass 
into  the  rectum,  and  hence  there  will  be  no  "call" 
and  no  movement.  It  is  evident,  also,  that  if  the 
amount  of  food  taken  is  small,  the  pelvic  loop  may 
be  so  long  a  time  in  filling  that  the  feces  which  first 
entered,  will  become  so  dry  and  compact  that  they 
may  form  a  mechanical  obstruction,  and  thus  the 
onward  movement  necessary  to  reach  the  rectum 
will  be  prevented,  even  though  the  bowel  may  rise, 
and  the  gate  which  guards  the  entrance  to  the 
rectum  may  be  open.  In  starvation,  no  "call" 
appears  because  there  is  nothing  with  which  to  fill 
the  loop  and  open  the  rectal  gate. 

Bodily  movement  has  a  certain  amount  of  influ- 
ence upon  the  position  of  the  loop  and  the  entrance 
of  feces  into  the  rectum,  especially  deep  breathing 
exercises,  and  bodily  exercises  which  produce  deep 
breathing.  In  deep  breathing,  the  diaphragm  is 
pushed  down  upon  the  abdominal  viscera,  compress- 
ing the  colon  as  well  as  other  parts  against  the  ab- 


NORMAL  BOWEL  ACTION  45 

dominal  wall.  By  this  means  the  feces  in  the  loop 
may  be  pushed  through  the  fold  into  the  rectum, 
thus  evoking  a  "call." 

The  increased  depth  of  breathing  and  the  com- 
pression of  the  abdomen  resulting  from  movement 
when  one  first  awakens  in  the  morning  are  no  doubt 
the  reasons  why  many  persons  experience  a  "call" 
almost  immediately  upon  awakening  after  a  full 
night's  rest.  During  sleep  the  pelvic  loop  has  been 
quietly  filling  and  rising,  but  the  pressure  has  not 
been  quite  sufficient  to  cause  the  feces  to  pass  into 
the  rectum.  A  push  from  the  diaphragm  and  the 
abdominal  muscles  gives  the  little  extra  help  needed 
and  the  "call"  comes. 

By  straining  movements,  such  as  accompany 
bowel  evacuation,  sufficient  fecal  matter  may  be 
pushed  over  into  the  rectum  to  create  an  effective 
"call,"  when  not  previously  felt.  Hence  the  import- 
ance of  going  regularly  to  stool  even  though  no 
"call"  is  experienced. 

A  cold  morning  bath  helps  in  the  same  direction, 
both  by  causing  deep  respiratory  movements,  which 
increase  the  intra-abdominal  pressure,  and  by  caus- 
ing a  reflex  contraction  of  the  colon. 

These  facts  are  mentioned  here  in  order  to  bring 
the  explanation  of  the  "call"  within  the  range  of 
common  every-day  experience,  and  to  show  its  very 
important  bearing  upon  the  practical  management 
of  cases  of  constipation. 

The  act  of  swallowing  a  glass  of  water,  espec- 


46  COLON  HYGIENE 

ially  the  drinking  of  cold  water,  and  above  all  other 
things  the  taking  of  food,  by  setting  up  peristaltic 
iTiovements  may  produce  a  "call,"  provided  there 
is  at  the  tinre  a  quantity  of  feces  in  the  pelvic  loop. 
If  the  loop  is  empty,  food  taking  or  anything  else 
which  sets  up  intestinal  peristalsis  will  serve  to 
help  the  feces  along  toward  the  pelvic  colon,  thus 
leading  to  a  "call"  a  little  later.  The  immediate 
effect  of  any  such  stimuli  will  of  course  depend 
upon  the  position  of  the  fecal  mass  in  the  colon. 
If,  for  example,  there  is  slight  delay  at  the  hepatic 
flexure,  perhaps  as  the  result  of  neglect  of  usual 
exercise  or  spending  a  day  in  bed,  the  use  of  meas- 
ures to  promote  intestinal  action  may  seem  to  pro- 
duce no  eifect,  whereas  a  bowel  movement  the  next 
morning  may  be  the  result  of  the  impulse  given 
to  the  fecal  mass  by  means  of  which  the  stagnation 
in  the  ascending  colon  was  overcome. 

The  Lost  "Call" 

The  "call"  to  bowel  movement  is  like  the  call 
of  the  alarm  clock  set  to  awaken  one  in  the  morn- 
ing. If  not  responded  to,  it  soon  ceases  to  be 
heard.  It  is  like  the  voice  of  conscience,  which  may 
be  wholly  stifled  by  continued  disregard.  This  is 
only  the  operation  of  a  general  biologic  law.  A  con- 
tinuous sensation  which  is  ignored,  by  and  by  fades 
out  of  the  consciousness.  For  example,  the  cloth- 
ing gives   rise   to   no   sensation   unless   adjusted   in 


NORMAL  BOWEL  ACTION  47 

some  unusual  fashion,  although  in  contact  with 
almost  the  entire  cutaneous  surface.  We  are  un- 
^  conscious  of  gloves  or  shoes,  although  our  hands 
or  feet  may  be  tightly  compressed.  So,  if  the  "call" 
evoked  by  the  pressure  of  feces  upon  the  nerves  of 
the  rectum  is  not  responded  to,  after  the  lapse  of  a 
certain  time  the  "call"  is  no  longer  heard.  A  mass 
of  feces  may  lie  in  the  rectum,  but  it  produces 
no  sensation.  The  vi^riter  has  many  times  found 
large  fecal  masses  in  the  rectum  of  which  the  pa- 
tient was  wholly  unconscious,  although  in  some 
instances  there  was  evidence  that  they  had  been 
present  in  the  lower  bowel  for  days  or  even  weeks. 
The  first  time  a  "call"  is  disregarded  it  vdll 
return  again  when  additional  fecal  matter  is  pushed 
down  from  the  pelvic  colon  by  the  stimulus  of  the 
next  meal,  or  as  the  result  of  some  other  influence 
which  excites  intestinal  action  or  increases  intra- 
abdominal tension.  After  having  been  disregarded 
or  resisted  many  times,  however,  the  "call"  becomes 
less  and  less  distinct,  and  by  and  by  ceases  entirely. 
The  rectal  nerves  have  lost  their  normal  sensibility. 
They  do  not  respond  to  the  irritation  produced  by; 
the  contact  of  fecal  matters,  but  have  acquired  i 
tolerance  for  such  contact,  just  as  the  nerves  of 
taste  may  become  accustomed  to  contact  with  hot 
apices,  so  that  they  no  longer  cause  any  disagreeable 
sensation,  or  the  skin  may  cease  to  react  to  a  mustard 
plaster,  so  that  a  stronger  irritant,  as  croton  oil  or 
a  hot  iron,  must  be  required  to  produce  a  blister. 


48  COLON  HYGIENE 

This  condition  of  lost  sensibility  is  one  of  the 
most  common  causes  of  constipation,  and  a  condition 
which  is  sometimes  very  difficult  to  remove,  although 
alwaj^s  conquerable  by  persevering  effort,  thanks 
to  the  great  light  thrown  upon  these  cases  by  mod- 
ern medical  research. 

To  lose  one's  "call"  is  almost  as  bad  as  to  lose  a 
fortune;  indeed  such  a  loss  has  more  than  once  led 
to  loss  of  fortune,  and  to  worse  results.  A  "call" 
that  has  been  lost  must  be  most  assiduously  sought 
for  until  recovered,  and  put  into  efficient  operation. 
The  methods  for  accomplishing  this  will  be  de- 
scribed at  length  in  a  later  chapter. 

Why  Do  the  Bowels  Move  Periodically? 

There  are  two  factors  which  are  chiefly  active 
in  producing  bowel  movements  in  normal  individ- 
uals. The  first  is  the  practice  of  taking  food  only 
at  stated  intervals,  regular  meal  hours.  The  sec- 
ond is  regularity  in  the  hours  of  sleep  and  morning 
rising.  The  omission  of  a  meal,  or  a  change  in 
the  hours  of  meals  or  of  sleep  will  at  once  change 
or  destroy  the  rhythm  of  bowel  movements.  Ani- 
mals that  eat  continuously,  as  monkeys  and  barn- 
yard fowls,  have  bowel  movement  many  times  a  day. 

The  taking  of  food  is  the  most  active  of  all 
natural  excitants  of  bowel  action.  When  food  is 
taken  into  the  stomach,  it  produces  powerful  peris- 
taltic waves  which  traverse  the  whole  length  of  the 


NORMAL  BOWEL  ACTION  49 

intestine  and  carry  the  intestinal  contents  forward 
at  a  rate  several  times  faster  than  the  ordinary  rate 
of  progression;  the  larger  the  meal,  and  the  more  it 
is  relished,  the  more  pronounced  is  this  effect.  This 
explains  the  almost  universal  experience  that  the 
bowels  move  most  freely  and  regularly  soon  after 
the  morning  meal. 

On  rising  in  the  morning  after  a  full  night's 
sleep,  so  long  a  time  has  elapsed  since  the  last  bowel 
movement  that  the  feces  have  accumulated  in  the 
pelvic  loop  and  the  descending  colon,  and  it  is  only 
necessary  that  sufficient  stimulus  should  be  applied 
to  cause  feces  to  enter  the  rectum,  and  a  "call" 
and  bowel  movement,  will  follow.  The  act  of  ris- 
ing, sometimes  the  mere  awakening  and  the  accom- 
panying turning  and  stretching  movements,  are 
often  sufficient  to  accomplish  this.  During  sleep, 
the  intestinal  movements  are  slowed.  The  progress 
of  the  intestinal  contents  along  the  canal  is  at  a 
much  slower  rate  than  during  the  waking  hours. 
This  is  easily  shown  by  X-ray  observations  after 
a  bismuth  meal.  At  the  moment  of  awakening, 
all  the  bodily  movements  are  quickened.  The  heart 
beats  faster,  the  force  of  the  breathing  is  increased, 
and  the  whole  vital  machine  feels  the  impulse  of 
quickened  energies.  If  the  pelvic  colon  has  been 
slowly  filling  during  the  night,  the  various  influences 
which  are  brought  into  play  at  the  moment  of 
awakening  will  be  likely  to  cause  the  passage  of  a 
sufficient   quantity   of   feces   from   the   pelvic   loop 


50  COLON  HYGIENE 

into  the  colon  to  produce  a  "call"  and  an  evacu- 
ation. 

Regularity  of  bowel  movement  is  of  the  utmost 
importance.  It  is  a  function  which  should  be  assidu- 
ously cultivated.  As  we  have  seen,  the  periodicity 
of  alvine  evacuation  is  not  the  result  of  any 
mysterious  influence,  but  is  a  product  of  forces 
which  are  largely  in  our  own  control  and  are  easily 
understood. 


The  Feces 

The  composition  of  the  colon  contents,  the  feces, 
is  very  complicated  and  highly  variable,  depend- 
ing very  largely  upon  the  character  of  the  food. 
The  bowel  discharges  of  the  nursing  infant  consist 
of  fragments  of  undigested  curds,  fat,  bile  and  a 
small  amount  of  mucus.  The  odor  of  a  healthy 
infant's  stool  is  slightly  acid,  and  yellowish  in  color. 
The  stool  of  an  adult  who  subsists  upon  an  ordi- 
nary mixed  diet  contains  a  considerable  amount  of 
food  residues,  seeds  and  skins  of  fruit,  cellulose 
from  vegetables,  and  such  whole-grain  cereals  as 
oat-meal  and  cracked  wheat,  and  also  contains  one 
or  two  per  cent  of  starch,  about  the  same  amount 
of  fat,  and  three  or  four  per  cent  of  protein.  Sugar 
is  not  present.  The  color  is  usually  dark  brown, 
often  black,  and  the  odor  putrid.  The  form  varies 
to  a  marked  degree. 

The  stools  of  a  person  who  subsists  on  a  nat- 
ural non-flesh  diet  closely  resemble  those  of  a  healthy 
infant.  The  odor  is  not  putrid,  but  may  be  slightly 
sour. 

Strassburger  has  shown  that  about  half  the 
solids  of  fecal  matter  is  made  up  of  bacteria. 
When  the  stools  are  putrid  it  is  because  of  the  domi- 
nance of  the  special  bacteria  which  give  rise  to  putre- 
faction. In  sour  smelling  stools,  however,  the  bac- 
teria present  are  chiefly  those  of  the  sort  which  cause 

51 


52  COLON  HYGIENE 

fermentation  and  give  rise  to  acid.  The  sour  odor  is 
due  to  the  presence  of  acetic  acid,  which  is  more  or 
less  volatile  at  low  temperatures.  Lactic  acid  is  also 
present.  As  it  is  non-volatile,  its  presence  is  shown 
only  by  chemical  tests,  not  by  the  odor. 

The  general  belief  that  the  feces  or  stools  con- 
sist chiefly  of  the  unusable  remains  of  foodstufEs  is 
entirely  erroneous.  As  a  matter  of  fact,  even  under 
the  most  unfavorable  conditions,  the  feces  contain 
really  very  little  food  material. 

Composition  of  the  Feces 

The  chief  constituents  of  the  feces  are  as  follows: 
Bile,  remains  of  digestive  juices,  especially  of  the 
pancreatic  juice,  mucus,  excretory  substances  thrown 
ofE  by  the  intestinal  mucous  membrane,  microbes 
and  various  poisons  produced  by  microbes,  such  as 
indol,  skatol,  pyrrol,  and  numerous  other  poisons, 
together  with  some  small  amounts  of  the  various 
food  principles,  and  water. 

The  composition  of  the  stool  varies  greatly 
according  as  the  diet  contains  much  or  little  of 
vegetables.  On  a  vegetable  diet  the  feces  contain 
much  cellulose,  and  with  the  cellulose  are  increased 
quantities  of  undigested  protein  and  starch.  The 
amount  of  fat  does  not  vary  much,  and  sugar  is 
never  present. 


THE  FECES  53 

Quantity 

The  weight  of  feces  varies  very  much  with  the 
diet,  increasing  with  a  vegetable  diet,  and  diminish- 
ing with  a  diet  composed  chiefly  of  animal  substances. 
Food  which  contains  much  cellulose  passes  through 
the  intestine  much  more  quickly  than  does  animal 
food,  and  hence  contains  more  water  and  undigested 
food  principles.  The  total  weight  of  the  feces  for 
twenty-four  hours  with  a  mixed  diet  is  about  five 
ounces,  of  which  three-fourths  is  water.  With  a 
vegetable  diet  the  weight  is  double,  the  proportion 
of  solid  matter  being  slightly  greater. 

The  Microbes  of  tlie  Intestine 

The  reaction  of  the  feces  is  neutral  or  slightly 
acid  on  a  vegetable  diet,  and  strongly  alkaline  on  a 
flesh  or  mixed  diet.  This  difference  in  reaction  is 
due  to  the  difference  in  the  flora  or  species  of  bac- 
teria which  are  present.  Feces  that  are  rich  in 
protein,  the  result  of  a  mixed  or  flesh  diet,  contain 
enormous  quantities  of  putrefactive  bacteria,  which 
produce  alkaline  substances  in  decomposing  the 
proteins — ammonia,  ptomaines,  and  various  toxins. 
When  considerable  quantities  of  starch  are  present, 
as  with  a  vegetable  diet,  with  very  little  protein, 
acid-forming  bacteria  are  dominant,  and  hence  the 
feces  have  an  acid  or  neutral  reaction. 

This  difference  in  reaction  is  one  of  the  most 
important  of  all  the  various  characteristics  of  the 


54  COLON  HYGIENE 

feces,  since  it  suggests  at  once  the  general  character 
of  the  flora,  and  thus  points  to  the  toxic  or  non- 
toxic character  of  the  stool. 

Roger  calls  attention  to  more  than  one  hundred 
and  sixty  different  species  of  bacteria  which  have 
been  found  in  the  feces.  Of  these,  more  than  one- 
third  were  found  to  possess  pathogenic  or  disease- 
producing  properties.  Distaso  points  out  more  than 
twenty  species  of  putrefactive  bacteria  which  are 
found  in  the  stools  of  flesh  eaters,  all  of  which  pro- 
duce very  highly  toxic  products.  One  of  the  most 
common  and  abundant  of  these  is  the  Bacillus  of 
Welch,  which  produces  enormous  quantities  of 
offensive  gas  and  highly  active  poisons.  This 
microbe,  as  well  as  the  other  putrefactive  organisms 
which  are  found  in  the  feces,  is  found  in  an  active 
growing  condition  in  butcher's  meat  and  fresh  flesh 
foods  of  all  sorts,  as  well  as  salted  and  dried  fish. 
This  is  doubtless  the  chief  source  of  the  dangerous 
bacteria  which  carry  on  in  the  body  the  same  putre- 
factive processes  to  which  they  give  rise  outside 
of  the  body. 

The  number  of  these  microbes  in  the  feces  is 
something  prodigious.  They  often  constitute  from 
one-third  to  one-half  the  total  weight  of  dried  feces. 
Strassburger  estimates  the  weight  of  the  microbes 
produced  in  the  intestines  in  a  single  day  at  not  less 
than  one-quarter  of  an  ounce,  and  the  number  more 
than  one  hundred  trillions,  of  which  a  large  propor- 
tion may  be  poison-forming  organisms.    Only  a  small 


THE  FECES  55 

share  of  the  bacteria  are  found  alive  in  the  feces  (one 
per  cent,  according  to  Strassburger) ,  but  all  have 
been  alive  and  have  each  produced  its  portion  of 
poisonous  substances  in  breaking  up  the  protein  upon 
which  it  feeds. 

The  study  of  these  bacteria  is  one  of  the  most 
important  fields  of  research  at  present  before  the 
bacteriologist,  for  it  has  been  clearly  shown  that 
the  condition  of  the  flora  of  the  intestine  is  one  of 
the  most  important  of  all  factors  in  determining 
health  or  disease,  long  or  short  life.  Of  this  subject 
we  shall  learn  more  in  a  subsequent  chapter. 

Excretory  Products 

Not  the  least  important  constituents  of  the  feces 
are  the  waste  products  which  they  contain,  a  fact 
quite  too  often  overlooked.  The  mucous  membrane 
of  the  intestinje,  like  the  skin,  is  an  excretory  organ. 
Although  the  extent  of  the  intestinal  mucus  cov- 
ering is  only  seven  square  feet,  about  one-third  of 
that  of  the  skin,  there  is  reason  for  believing 
that  its  importance  as  an  outlet  is  fully  as  great 
as  that  of  the  skin,  and  probably  much  greater.  This 
fact  has  only  recently  been  made  known.  By  the 
researches  of  Roger  and  others,  it  has  been  shown 
that  the  mucous  membrane  removes  from  the  body 
some  of  the  most  deadly  poisons  which  are  produced 
in  our  tissues,  or  which  may  be  introduced  from 
without.     If,  for  example,  a  quarter  of  a  grain  of 


56  COLON  HYGIENE 

morphia  is  injected  underneath  the  skin  of  a  person, 
a  large  part  of  the  poison  will  be  found  in  the 
stomach  and  intestine  within  a  half  hour.  This  ex- 
cretion of  poisons  appears  in  the  light  of  these  new 
researches  to  be  one  of  the  important  offices  of  the 
stomach. 

Lime  salts  which  are  no  longer  needed  in  the  body 
are  excreted  through  the  intestine. 

The  bile  poured  into  the  intestine  contains  some 
of  the  most  deadly  poisons  produced  in  the  body. 
Bouchard  found  the  bile  to  be  six  times  as  toxic  as 
the  urine. 

Examination  of  the  Stools 

When  a  doctor  is  called  to  see  a  sick  infant,  he 
first  of  all  inquires  as  to  the  bowel  passages,  and 
the  experienced  nurse  or  mother  always  preserves 
the  infant's  napkins  to  show  to  the  doctor  when  he 
comes.  If  the  bowel  passages  have  the  usual  con- 
sistency and  yellowish  color  and  a  slightly  acid  odor, 
the  doctor  knows  that  there  is  no  serious  disturb- 
ance of  digestion;  but  if  the  stools  are  dark  or 
brownish  in  color  and  have  a  foul  or  putrid  odor, 
this  fact  alone  is  sufficient  to  show  to  the  physician 
or  experienced  nurse  that  the  infant  is  sick.  Any 
physician  who  would  omit  to  examine  the  stools  of 
an  infant  when  called  in  consultation,  would  be 
regarded  either  as  ignorant  or  as  quite  remiss  in  his 
duty. 


THE  FECES  57 

It  is  very  strange  indeed  that  until  quite  recently 
almost  no  attention  has  been  given  to  the  stools  of 
adults,  and  even  at  the  present  time  physicians  quite 
rarely  take  the  trouble  to  make  anything  like  a 
thorough  investigation  of  bowel  passages.  The  doc- 
tor usually  contents  himself  by  inquiring  if  the 
bowels  move  regularly.  When  questioned  concern- 
ing the  character  of  their  stools,  most  patients  are 
unable  to  give  any  information.  Something  can  be 
learned  from  the  general  appearance  of  the  stools, 
but  for  really  useful  information  it  is  necessary  to 
submit  a  specimen  to  a  thorough  laboratory  investi- 
gation at  the  hands  of  an  expert  in  this  particular 
line  of  research. 

It  is  not  going  too  far  to  say  that  a  thorough 
examination  of  the  stools  should  be  made  in  every 
case  of  chronic  disease.  This  practice  has  already 
been  instituted  in  a  few  medical  institutions  where 
a  high  degree  of  medical  work  is  done,  and  the  time 
cannot  be  far  distant  when  such  an  examination  will 
be  a  routine  practice  with  all  physicians  who  attempt 
to  keep  abreast  with  the  advance  of  medical  science. 


Influences  Which  Excite  Move- 
ments of  the  Colon 

The  food  tube  is  controlled  by  two  sets  of  nerves. 
One,  the  motor,  excites  contractions  of  the  intes- 
tine, while  the  other  opposes  this  action,  causing, 
cessation  of  movement  and  relaxation  of  the  intes- 
tine. The  motor  nerves  are  derived  from  the  brain 
and  spinal  cord;  those  of  the  second  class,  known  as 
splanchnic  nerves,  from  the  sympathetic. 

A  very  remarkable  and  interesting  fact  relating 
to  the  action  of  these  nerves  should  be  mentioned 
here  as  an  aid  to  a  full  understanding  of  their  action. 
When  the  motor  nerves  of  the  intestine  are  stimu- 
lated, they  cause  powerful  contraction  of  both  the 
intestine  and  the  abdominal  walls,  but  relaxation  of 
both  the  internal  and  external  anal  sphincters. 
When  the  sympathetic  or  splanchnic  nerves  of  the 
intestine  are  stimulated,  they  cause  relaxation  of 
the  intestines,  with  cessation  of  movement,  and  at 
the  same  time  strong  contraction  of  the  ileocecal 
sphincter.  These  two  facts  explain  many  important 
phenomena  in  relation  to  bowel  movement  and  con- 
stipation. 

The  relaxation  of  the  anal  sphincters  when  the 
colon  and  abdominal  muscles  contract,  is  necessary 
to  facilitate  the  discharge  of  feces  from  the  bowels. 
This  fact  wholly  agrees  with  the  interesting  obser- 

58 


INFLUENCES  WHICH  EXCITE  MOVEMENTS      59 

vations  of  Bayliss  and  Starling,  that  mechanical 
excitation  of  the  intestine  causes  contraction  at  and 
above  the  point  of  irritation,  and  relaxation  below, 
a  most  beneficent  and  wonderful  adaptation  of 
means  to  ends. 

One  more  important  fact  is  especially  worthy  of 
note  in  this  connection,  viz.,  that  the  intestine  is  sup- 
plied with  nerve  ganglia  of  its  own,  located  within 
its  walls,  between  its  two  layers  of  muscles,  so  that 
it  may  act  even  when  all  cerebro-spinal  and  sympa- 
thetic nerves  are  cut  in  experiment  or  paralyzed  in 
disease.  A  small  bit  of  stomach  or  intestine  removed 
from  a  living  animal,  when  stimulated  by  electricity 
does  not  contract  in  continuous  spasm  as  do  ordinary 
muscles,  but  contracts  rhythmically,  as  does  the 
heart  and  other  involuntary  muscles.  This  is  true, 
however,  only  when  the  nerve  ganglia  are  removed 
with  the  muscle  tissue. 

The  Bile 

The  bile  is  a  normal  stimulant  to  the  colon,  but 
for  some  curious  reason  does  not  act  upon  the  small 
intestine.  This  seems  unfortunate,  for  there  is  an 
increasing  volume  of  evidence  that  in  some  of  the 
most  obstinate  forms  of  constipation  the  chief  cause 
of  trouble  is  located  in  the  small  intestine.  Possibly 
the  biliary  secretion  of  the  degenerate  modern  civil- 
ized man  has  lost  something  of  its  original  value  as 
a  laxative.    The  best  proof  of  the  laxative  property 


60  COLON  HYGIENE 

of  the  bile  is  found  in  the  remarkable  colon-stimu- 
lating properties  of  "bilen,"  an  extract  prepared 
from  the  bile,  which  when  introduced  into  the  rec- 
tum often  produces  active  peristalsis  within  a  few 
minutes,  with  vigorous  bowel  movement. 

A  recent  discovery  has  shown  that  the  spleen  also 
produces  a  substance  which  powerfully  stimulates 
the  intestinal  peristalsis.  This  substance,  however, 
acts  upon  both  the  small  and  the  large  intestine. 

Another  remarkable  substance,  pituita,  produced 
by  a  small  gland  in  the  brain,  the  pituitary  body,  is 
a  most  powerful  stimulant  to  the  entire  intestinal 
tract. 

It  seems  hardly  necessary  to  devote  space  to  em- 
phasizing the  importance  of  so  guarding  the  interests 
of  the  liver  and  spleen  as  to  receive  constantly  the 
full  benefit  of  the  powerful  aid  these  organs  are 
capable  of  giving  to  the  muscular  movements  of  the 
alimentary  canal. 

The  intestine  has  two  special  senses,  the  muscular 
sense,  which  it  possesses  in  a  very  high  degree,  and 
a  fine  tactile  sense  located  in  its  mucous  lining. 
The  muscular  sense  is  excited  by  distension  of  the 
intestine,  which  causes  tension  of  its  muscular  walls. 

The  Influence  of  Bulk 

In  operations  upon  the  stomach  and  intestines, 
the  influence  of  mechanical  stimulation  is  often  seen. 
Slight  pressure  upon  the  wall  of  the  stomach  or  of 


INFLUENCES  WHICH  EXCITE  MOVEMENTS      61 

the  intestine  is  sufficient  to  set  up  a  contraction 
which  follows  in  a  few  seconds.  Contraction  of 
the  intestine,  as  shown  by  Bayliss  and  Starling,  is 
accompanied  by  dilatation  of  the  intestine  lower 
down,  so  that  room  may  be  made  for  the  material 
that  is  being  pushed  along.  Contact  of  the  food 
with  the  interior  of  the  intestine  produces  like  ef- 
fects. The  greater  the  bulk  of  the  food,  the  greater 
the  effect.  As  shown  by  Cannon,  segmentation,  a 
most  effective  means  of  food  propulsion,  becomes 
really  active  only  when  the  bowel  is  distended. 

All  foods  which  are  completely  digested  and  ab- 
sorbed by  the  intestine,  leaving  little  or  no  residue, 
discourage  peristalsis.  This  is  the  reason  why  rice, 
boiled  milk,  and  fine  flour  bread  have  become  gener- 
ally known  as  constipating  foods.  These  foods  are 
not  actively  constipating;  they  simply  do  not  leave 
sufficient  indigestible  residue  to  afford  the  necessary 
mechanical  stimulation  of  the  intestine. 

In  general,  all  animal  foods  encourage  consti- 
pation, for  the  reason  that  they  are  completely 
soluble  in  the  digestive  fluids.  Hair,  feathers  and 
bones  are  almost  the  only  animal  tissues  not  capable 
of  complete  solution  in  the  digestive  juices.  It  is 
in  part  for  this  reason  that  carnivorous  animals  usu- 
ally eat  bones  with  the  flesh  on  which  they  feed ; 
the  bones  are  of  course  necessary  also  for  the  lime 
which  they  contain,  and  which  is  almost  wholly 
lacking  in  the  soft  tissues  of  animals.  Most  carniv- 
orous animals  also  eat  more  or  less  vegetable  food. 


62  COLON  HYGIENE 

Cats  and  dogs  often  nibble  grass,  and  special  weeds, 
of  which  they  appear  to  be  extremely  fond.  Fowls 
swallow  feathers  and  sand.  Horses  sicken  when 
fed  on  corn  alone.  They  must  have  a  liberal  supply 
of  coarser  material.  A  Maine  ship  captain  saved  a 
cargo  of  mules,  when  the  supply  of  hay  was  swept 
overboard,  by  feeding  them  shavings  made  by  the 
ship  carpenters.  A  number  of  horses  in  the  cargo 
refused  to  eat  the  shavings  and  died.  In  England, 
when  the  price  of  grain  is  high,  the  farmers  feed 
their  stock  on  treacle,  which  is  exceedingly  cheap, 
combined  with  wood  sawdust,  and  with  good  results. 
The  animals  readily  fatten  on  this  diet,  and  remain 
in  good  health. 

Most  primitive  people  recognize  the  need  of  bulk 
to  maintain  healthy  action  of  the  alimentary  canal. 
The  Japanese  and  Chinese  make  large  use  of 
various  seaweeds.  One  of  these  under  the  name  of 
agar-agar  has  come  to  be  well  known  in  this  country. 

Agar-agar  is  prepared  from  a  sea-weed  that  grows 
on  the  coast  of  Japan  and  Ceylon.  It  is  sometimes 
known  in  commerce  as  Ceylon  moss.  It  is  also 
known  as  Japanese  isinglass  or  vegetable  gelatine, 
It  does  not,  however,  have  the  composition  of  gela- 
tine. Its  composition  is  practically  identical  with 
cellulose.  It  is  almost  wholly  indigestible  in  the 
hunian  alimentary  canal.  The  commercial  product 
is  prepared  by  cooking  the  seaweed  with  much 
water  in  large  kettles,  then  cooling  the  solution,  and 
passing  it  through  colanders  by  which  it  is  formed 


INFLUENCES  WHICH  EXCITE  MOVEMENTS      63 

into  long  strings.  These  are  dried  in  the  sun,  and 
then  bleached  in  the  sun  and  dew  for  several  weeks. 
This  material  is  brought  to  the  United  States  in 
large  bales.  In  its  commercial  form,  as  it  is  obtain- 
able at  many  drug  stores,  agar-agar  is  hardly  fit  to 
be  placed  in  the  stomach.  It  needs  to  be  thoroughly 
washed  and  disinfected  by  peroxide  of  hydrogen  or 
some  other  efficient  means.  It  is  also  very  tough  and 
inedible. 

Mr.  George  Kennan,  the  celebrated  Siberian 
traveler,  stated  to  the  writer  that  the  Eskimos  eat 
half  digested  reindeer  moss  as  a  remedy  for  and  pre- 
ventive of  constipation.  The  moss  is  obtained  by 
killing  the  reindeer  at  a  certain  time  after  feeding, 
removing  the  moss  from  the  stomach,  and  submit- 
,  ting  it  to  a  very  slight  and  simple  preparation. 

The  natives  of  Japan  and  China  eat  quantities 
of  dried  raw  turnip,  bamboo  sprouts,  lily  flowers 
and  roots  and  other  vegetables  with  the  rice  which 
forms  the  staple  food  of  these  people. 

The  Alaska  Indians  gather  and  dry  a  seaweed, 
which  they  eat  at  all  seasons  as  a  laxative. 

A  missionary  nurse  working  among  the  Alaska 
Indians,  sent  us  a  few  years  ago  a  sample  of  the 
seaweed  which  is  used  in  its  native  state  by  these 
people  to  prevent  the  constipation  which  would  nat- 
urally result  from  the  nearly  exclusive  fish  diet  on 
which  these  Indians  are  compelled  to  subsist  at 
certain  seasons  of  the  year.  The  sea-weed  is  simply 
gathered  and  dried  in  the  sun  and  pressed  into  large 


64  COLON  HYGIENE 

flat  cakes  between  flat  stones.  The  material  thus 
prepared  is  very  black  in  color  but  is  crisp  and  not 
unpleasant  in  flavor. 

The  Hopi  Indian  makes  a  good  laxative  food  by 
grinding  up  in  a  stone  mortar  the  whole  nut  of  the 
pinon,  including  the  shell. 

The  Highland  Scotchman  escapes  the  constipa- 
tion which  would  otherwise  result  from  his  diet  of 
buttermilk,  oatmeal  and  potatoes,  by  eating  his  brose 
(oatmeal)  in  a  half  raw  state. 

The  wild  Arab  supplements  his  diet  of  camel's 
milk  and  dates  with  wheat  ground  in  a  stone  mill, 
which  supplies  all  the  cellulose  of  the  bran,  with  the 
addition  of  a  certain  amount  of  pulverized  stone. 

The  Orinoco  Indians  and  the  poor  whites  of  the 
Tennessee  Mountains  combat  constipation  by  eating 
considerable  quantities  of  clay,  as  do  horses  and 
other  anim.als  when  fed  on  a  too  concentrated  diet. 

The  desire  for  bulky  green  things,  which  afford 
much  bulk  with  little  nourishment,  that  almost 
every  one  experiences  in  the  early  spring  time,  when 
the  oncoming  heat  reduces  the  bulk  of  the  food  by 
lessening  the  appetite,  is  an  instinctive  prompting 
which  cannot  be  disregarded  without  injury. 

A  western  pioneer,  who  was  shut  up  in  the  moun- 
tains of  the  Coast  Range  by  an  early  fall  of  snow, 
and  confined  for  three  months  with  several  com- 
panions and  a  number  of  mules  with  no  food  but 
corn  meal,  escaped  without  injury,  although  his 
associates  all  suffered  extremely  from  scurvy,  by  fol- 


INFLUENCES  WHICH  EXCITE  MOVEMENTS       65 

lowing  the  example  of  the  mules,  who  dug  tunnels 
in  the  fifteen-foot  snow  drifts  and  ate  the  grass  hid- 
den underneath. 

A  diet  consisting  largely  of  meat,  eggs,  milk,  cane 
sugar  and  fine  flour  bread,  leaves  little  or  no  residue 
to  act  as  a  stimulus  to  the  intestinal  muscles.  The 
free  use  of  greens  and  salads  of  lettuce,  cabbage  and 
other  uncooked  foods  fresh  from  the  garden  is  essen- 
tial to  healthy  intestinal  activity. 

The  Sugars 

Other  elements  of  the  food  besides  bulk,  exert  a 
marked  influence  upon  the  activity  of  the  digestive 
organs.  All  the  sugars  stimulate  intestinal  activity. 
Roger  thinks  this  action  is  confined  to  the  small 
intestine,  but  in  this  he  is  in  error,  for  every  abdom- 
inal surgeon  knows  the  remarkable  laxative  effects 
of  an  enema  consisting  of  a  half  pint  of  molasses  with 
an  equal  amount  of  hot  water. 

Cane  sugar  is  undesirable,  however,  because  of 
its  irritating  effects.  The  sugars  of  fruits — levu- 
lose  and  dextrose — are  wholesome  and  efficient.  The 
malt  sugar  produced  by  the  action  of  the  saliva  upon 
starch  is  of  great  service  as  a  stimulant  of  gastric  and 
intestinal  activity.  Many  mothers  know  of  the 
laxative  effect  of  milk  sugar  added  to  the  infant's 
food.  Malt  sugar  is  better,  because  free  from  germs, 
and  more  native  to  the  body  than  the  sugar  of  cow's 
tniik. 


66  COLON  HYGIENE 

Malt  sugar,  as  shown  by  recent  experiments,  is 
absorbed  in  one-fourth  the  time  required  for  milk 
sugar. 

Fruit  and  Vegetable  Acids 

The  acids  of  fruits  and  vegetables — citric,  malic, 
and  tartaric, — are  excellent  laxatives.  This  is,  in 
part  at  least,  the  explanation  of  the  good  effects  of 
an  orange  taken  at  night  or  before  breakfast.  All 
acid  fruits  are  laxative.  The  tomato,  a  vegetable 
fruit,  is  a  most  excellent  stimulant  of  intestinal 
action,  chiefly  through  its  citric  acid.  When  possible, 
the  tomato  as  well  as  other  acid  fruits  should  be 
eaten  raw,  to  obtain  the  best  effects. 

Lactic  and  acetic  acids,  developed  in  the  Intes- 
tines by  the  growth  of  harmless  acid-forming  bac- 
teria, are  a  powerful  stimulant  of  intestinal  action. 
A.  Schmidt  of  Halle,  Germany,  has  demonstrated 
that  these  acids  are  the  normal  stimulants  of  the 
colon.  When  they  are  present  in  sufficient  amount, 
bowel  activity  is  normal.  Putrefaction  produces  an 
alkaline  condition  in  the  colon  which  has  a  paralyz- 
ing effect  upon  the  intestinal  movements.  Sour  milk 
and  buttermilk  produce  a  decided  laxative  effect  in. 
many  persons,  especially  in  children. 

Fats 

Oils  and  fats  stimulate  Intestinal  action.  Not 
only  fats  themselves,  but  the  glycerine  and  soaps 


INFLUENCES  WHICH  EXCITE  MOVEMENTS      67 

which  are  formed  by  the  digestion  or  decomposition 
of  fats  in  the  intestine,  are  very  active  stimulants 
of  intestinal  movements. 

Mineral  oil — white  Russian  paraffin  oil — being 
indigestible  and  unabsorbable,  is  a  very  powerful 
stimulant  of  intestinal  activity.  It  adds  to  the  bulk 
of  the  food,  lubricates  the  food  canal,  hinders  the 
excessive  absorption  of  water,  and  keeps  the  bowel 
contents  moist. 

Gases 

The  carbonic  acid  gas  and  other  gases  formed  in 
the  intestine  by  the  fermentation  of  starch,  cellulose, 
and  other  foodstuffs  are  powerful  stimulants  to  the 
muscular  activity  of  the  bowel.  When  present  in 
excess,  gases  cause  spasm  of  the  circular  muscles  of 
the  intestine,  with  sharp  colic  pains. 

Eating 

The  taking  of  food  into  the  stom.ach  is  by  far 
the  most  powerful  of  all  the  natural  stimulants  of 
the  intestine.  Very  soon  after  food  enters  the  mouth, 
peristaltic  movements  begin  in  the  stomach,  and 
quickly  extend  the  whole  length  of  the  food  canal. 
This  is  the  reason  for  the  desire  to  evacuate  the 
bowels  which  m.ost  people  experience  soon  after  eat- 
ing breakfast.  The  peristaltic  waves  set  up  carry 
the  feces  down  into  the  rectum,  and  this  produces 
the  sensation  which  indicates  the  necessity  for  evacu- 
ation. 


68  COLON  HYGIENE 

It  has  been  shown  that  even  the  smell  of  agree- 
able food  is  sufficient  to  cause  increased  intestinal 
activity.  The  act  of  swallowing  also  excites  intes- 
tinal activity. 

X-ray  examinations  show  that  the  intestinal  con- 
tents move  four  times  as  fast  during  a  meal  as  during 
the  interval  between  meals. 

It  is  the  opinion  of  the  writer  that  bowel  move- 
ments should  occur  after  each  of  the  principal  meals 
of  the  daj^  This  question  is  discussed  further  in  a 
later  chapter. 

Psychic  Influences 

Pleasurable  emotions  and  excitement  have  been 
known  to  produce  intense  activity  of  the  intestines, 
and  even  diarrhoea,  while  depressing  emotions  have 
the  opposite  effect.  This  has  been  clearly  demon- 
strated experimentally,  in  animals  as  well  as  clin- 
ically in  human  beings. 

Electricity 

This  powerful  agent  may  be  applied  in  such  a 
way  as  greatly  to  stimulate  intestinal  activity.  The 
most  effective  method  is  the  application  of  the  sinu- 
soidal current  to  the  rectum  and  abdominal  muscles, 
or  to  the  rectum  and  the  central  portion  of  the 
back.  Another  very  effective  method,  perhaps  the 
most  efficient  of  all  methods,  is  the  application  of  a 


INFLUENCES  WHICH  EXCITE  MOVEMENTS      69 

bi-polar  electrode  to  the  inner  surface  of  the  pelvic 
colon,  which  is  the  point  of  greatest  delay  in  the 
majority  of  constipated  persons. 

Mechanical  Vibration 

Powerful  mechanical  impulses  may  be  communi- 
cated to  the  intestines  and  the  nerve  ganglia  which 
control  them,  by  suitable  apparatus.  The  writer 
has  in  numerous  instances  seen  strong  intestinal 
movements  set  up  by  this  form  of  stimulation. 

Massage 

This  is  another  valuable  means  of  stimulating  the 
bowel  to  increased  activity.  Kneading  with  the 
hands  or  with  a  suitable  mechanical  appliance  has 
been  shown  to  be  capable  of  quickening  the  move- 
ments of  the  intestine,  if  applied  with  sufficient 
thoroughness. 

Stroking,  or  reflex  titillation  of  the  skin,  stimu- 
lates the  bowel  in  much  the  same  way  that  tickling 
the  soles  of  the  feet  may  give  rise  to  powerful  con- 
tractions of  the  muscles  of  the  legs.  To  be  effective, 
massage  intended  to  influence  the  intestinal  move- 
ments must  be  given  by  an  expert. 

Abdominal  Compression 

This  method  acts  upon  the  intestine  by  increasing 
the  intra-abdominal  pressure.     It  is  most  effective 


70  COLON  HYGIENE 

when  applied  in  cases  in  which  the  abdominal  mus- 
cles are  weak  and  relaxed. 

The  compression  may  be  made  continuous  by 
the  application  of  a  tight  abdominal  bandage ;  or 
intermittent  pressure  may  be  applied,  if  desired,  by 
means  of  an  inflated  rubber  bag.  These  measures 
will  be  explained  more  fully  elsewhere. 

Exercise 

Bodily  activity  is  another  way  of  mechanically 
stimulating  the  intestine.  Vigorous  exercise  sets  the 
diaphragm  and  abdominal  muscles  at  work  in  such 
a  way  that  the  intestines  are,  between  the  two,  vig- 
orously kneaded  and  squeezed  and  thus  stimulated 
to  action. 

Every  farmer  knows  the  constipating  effect  of 
idleness  upon  his  horses  and  cattle.  Most  observing 
persons  have  noted  in  their  own  experience  the  ad- 
vantage of  taking  a  brisk  walk  before  or  after 
breakfast. 

The  sedentary  man  or  v\^oman  not  only  loses  the 
immediate  benefit  which  results  from  the  increased 
activity  of  the  diaphragm  and  abdominal  muscles, 
but  his  abdominal  muscles  become  permanently 
weakened,  relaxed,  lacking  in  tone,  and  incapable 
of  supporting  the  intestines  in  their  proper  place, 
thus  adding  a  number  of  other  factors  which  con- 
tribute very  materially  to  the  lessening  of  intestinal 
activity. 


INFLUENCES  WHICH  EXCITE  MOVEMENTS       71 

Posture 

A  stooped  or  relaxed  posture  In  sitting  or  standing 
tends  strongly  to  induce  constipation  by  weakening 
the  abdomial  muscles  and  causing  congestion  of  the 
liver  and  all  other  abdominal  organs.  The  viscera, 
over-filled  with  blood,  and  lacking  the  support  of  the 
abdominal  muscles,  become  prolapsed.  The  colon 
falls  with  the  rest;  kinks  are  formed;  the  intestinal 
contents  stagnate ;  the  bowel  becomes  distended ;  the 
ileocecal  valve  becomes  incompetent,  infection  trav- 
els up  the  small  intestine,  and  a  long  list  of  ills 
result.  The  check  valve  action  of  the  ileocecal  valve 
is  essential  to  the  onward  movement  of  the  food 
residues,  and  therefore  the  crippling  of  this  valve 
naturally  leads  to  constipation. 

An  erect  posture  secures  proper  exercise  of  the 
muscles  of  the  trunk,  correct  breathing,  normal  cir- 
culation of  blood  in  the  viscera,  and  promotes  in  a 
high  degree  normal  bowel  movement. 

Hot  and  Cold  Applications 

Cold  applications,  and  even  extremely  hot  appli- 
cations, act  as  powerful  stimulants  to  the  intestinal 
muscles.  To  be  efEective,  the  applications  must  be 
short  and  intense.  The  cold  spinal  and  abdominal 
douche,  and  the  cold  douche  to  the  feet  and  legs, 
are  the  most  effective  external  procedures. 

The  application  of  cold  water  to  the  bowel  by 
means  of  the  enema  at  a  temperature  of  75°  to  40° 


72  COLON  HYGIENE 

F.  produces  almost  instant  contraction  of  the  bowel. 
The  action  is  so  intense  that  great  pain  may  be 
produced,  especially  if  a  very  low  temperature  is 
employed. 


Influences  Which  Lessen  Intestinal 
Movements 

There  are  certain  foods  and  other  agents  and 
influences  that  exercise  a  decided  deterring  influence 
upon  intestinal  movements,  either  directly,  or  in- 
directly through  the  suppression  of  the  normal 
stimuli. 

Liquid  Foods 

Such  foods  as  soups,  gruels,  porridges,  and  purees 
contain  so  little  solid  matter  that  the  bulk,  consider- 
able though  it  may  be  when  the  food  is  eaten,  is 
soon  reduced  to  a  very  small  volume.  On  this  ac- 
count liquid  foods  are  almost  always  constipating. 
The  only  exceptions  are  those  liquid  foods  vi^hich 
contain  much  sugar,  acids,  or  fats. 

Pasty  cereals  such  as  oatmeal  mush,  are 
decidedly  constipating  in  their  influence,  because  of 
their  pasty  consistency  and  the  little  mastication 
which  they  receive.  New  bread,  hot  biscuits, 
."noodles,"  and  doughy  foods  of  all  sorts  are  like- 
wise objectionable. 

Concentrated  Foods 

Foods  which  contain  little  or  no  waste  or  In- 
digestible material  are  so  completely  digested  and 
absorbed  that  the  bulk  left  in  the  intestine  is  in- 

73 


74  COLON  HYGIENE 

sufficient  to  stimulate  segmentation  or  peristalsis.  In 
feeding  the  sick,  the  mistake  is  not  infrequently  made 
of  feeding  exclusively  fluid  or  concentrated  foods, 
with  the  idea  that  such  foods  tax  the  digestive 
organs  least.  In  a  sense  this  is  true,  but  the  impor- 
tance of  maintaining  proper  bowel  action  is  so  great 
that  this  must  be  considered  in  the  dietary,  and  with 
rare  exceptions  the  patient  will  perfectly  well  toler- 
ate simple  salads,  stewed  fruit  of  some  sort,  whole 
wheat  preparations,  especially  wheat  flakes,  in  which 
the  whole  grain  is  represented. 

The  conventional  "tea  and  toast"  is  about  the 
worst  diet  that  could  be  offered  a  sick  person.  The 
panadas,  puddings,  and  "slops"  of  various  sort  are 
little  better. 

The  Properties  of  Fruit  Juices 

Fruit  juices  of  all  sorts  are,  on  the  other  hand, 
most  suitable  for  almost  all  forms  of  sickness.  They 
contain  choice  nutriment  in  a  form  needing  no  di- 
gestion, ready  for  immediate  absorption  and  assimi- 
lation. 

Orange  juice  or  freshly  expressed  juice  of  ap- 
ples, grapes,  or  other  sweet  or  sub-acid  fruit,  is 
ideal  nourishment  for  the  sick.  In  the  absence  of 
these  fruits,  dried  fruit,  soaked  long  in  water  may 
furnish  a  very  fair  substitute.  Canned  fruit  juices 
come  next  in  value.  To  these  rice,  or  some  other 
cereal  food,  may  be  added  in  proper  amount,  with 
malt  sugar  in  some  form. 


INFLUENCES  WHICH  LESSEN  MOVEMENTS       75 

Fasting 

In  a  state  of  absolute  fasting  the  intestine  is  in 
a  state  of  complete  inactivity.  The  normal  stimulus 
of  food  is  lacking,  and  there  is  nothing  to  call  forth 
the  rhythmical  activities  which  accompany  normal 
digestion.  In  another  chapter  we  shall  discuss  at 
some  length  the  question  of  fasting  as  a  curative 
means,  a  method  which  has  almost  assumed  the 
character  of  a  fad  in  certain  sections. 

Pain 

Pain  in  almost  any  part  of  the  body  may  arrest 
intestinal  action  by  causing  a  reflex  interference. 
Pain  or  inflammation  in  any  part  of  the  abdomen, 
especially  such  painful  affections  as  rectal  ulcer  or 
fistula,  inflamed  hemorrhoids,  chronic  appendicitis, 
inflammation  of  the  bladder,  prostate,  uterus,  ovaries, 
and  other  pelvic  organs,  all  give  rise  to  inaction 
of  the  intestine,  not  only  by  inhibiting  or  preventing 
peristalsis,  but  also  by  causing  obstruction  through 
contraction  of  the  ileocecal  sphincter.  The  pain  and 
irritation  of  an  ulcer  or  fistula,  or  inflammed  hemor- 
rhoids, may  induce  constipation  by  causing  spasms  of 
the  anal  muscle,  and  so  preventing  the  normal  re- 
laxation in  the  act  of  defecation. 

Miscellaneous  Causes 

Depressing  emotions,  such  as  anger,  fear,  or  des- 
pondency, all  suppress  the  normal  movements  of  the 


76  COLON  HYGIENE 

intestine,  and  thus  form  a  vicious  circle  which  con- 
tinually aggravates  both  the  malady  and  its  cause. 

Heat  lovi^ers  muscular  tone,  and  hence  checks  the 
intestinal  movements.  This  is  w^ell  seen  in  the  relief 
obtained  by  the  application  of  a  fomentation  to  the 
abdomen,  or  the  administration  of  a  hot  bath  or  a 
hot  enema  in  a  case  of  intestinal  colic  or  diarrhoea. 

Hot  drinks,  as  well  as  hot  baths,  tend  to  slow 
intestinal  movements,  and  the  habitual  use  of  warm 
enemas  certainly  aggravates  the  condition  for  which 
the  treatment  is  given. 

Sweating,  if  very  profuse,  encourages  intestinal 
inactivity  by  removing  large  quantities  of  water 
through  the  skin,  and  thus  producing  excessive  dry- 
ness of  the  intestinal  contents. 

Elevated  body  temperature,  whether  caused  by 
fever  or  by  a  hot  bath  of  some  sort,  slows  the  intes- 
tinal movements. 

Sleep  and  inactivity  slow  the  intestinal  movements 
by  lessening  the  activity  of  the  diaphragm  and  the 
abdominal  muscles.  The  first  voluntary  movements 
made  on  awakening  in  the  morning  often  start  up 
peristalsis,  and  often  provoke  a  desire  for  evacuation 
of  the  bowels.  Persons  who  lead  inactive  lives  almost 
always  suffer  from  constipation,  though  often  un- 
aware that  this  is  the  case,  for  reasons  which  we 
shall  present  later. 

Prolonged  cold  sitz  baths  cause  intestinal  in- 
activity by  inducing  a  spasm  of  certain  of  the  food 
gates,  probably  the  ileocecal  sphincter.     This  result 


INFLUENCES  WHICH  LESSEN  MOVEMENTS       77 

occurs  if  the  bath  is  continued  for  more  than  seven  or 
eight  minutes.  When  for  any  reason  the  use  of  the 
prolonged  sitz  bath  becomes  necessary,  special  pre- 
cautions in  diet  and  otherwise  must  be  taken  to 
prevent  producing  this  undesirable  effect. 

A  diet  largely  made  up  of  meat  necessarily  favors 
intestinal  inactivity,  first  because  the  complete  diges- 
tion of  the  meat  leaves  too  little  residue  to  stimulate 
peristalsis,  and  second  because  an  excess  of  protein 
encourages  putrefactive  processes  in  the  intestine, 
which  establish  an  alkaline  condition  of  the  intestinal 
contents,  and  thus  prevent  normal  intestinal  activity. 
The  stools  of  flesh  eaters  usually  have  a  very  strong 
ammoniacal  odor,  and  when  tested  by  the  chemist 
are  found  to  be  strongly  alkaline.  Alkalies  paralyze 
the  colon,  while  acids  stimulate  it. 


The  Causes  of  Constipation 

The  causes  of  a  disease  so  universal  in  civilized 
communities  must  be  very  numerous  to  produce  this 
condition  in  so  great  a  number  of  people  living 
under  many  different  conditions,  and  with  different 
habits  of  life.  In  general  it  may  be  said  that  the 
causes  of  constipation  are  abnormal  habits  or  con- 
ditions of  life,  the  result  of  what  we  call  civilization. 
Savages  rarely  suffer  from  constipation,  which  is 
also  true  of  the  more  primitive  of  so-called  civilized 
nations.  Chronic  intestinal  inactivity  is  much  less 
frequent  among  country  people  than  among  those 
living  in  the  city.  It  is  manifestly  a  morbid  condi- 
tion peculiar  to  a  state  of  high  civilization;  and 
modern  medical  researches  tend  to  show  that  this 
condition  and  its  results  may  justly  be  looked  upon 
as  among  the  fundamental  causes  of  the  race  de- 
generacy which  is  becoming  every  year  more  apparent 
in  all  highly  civilized  comm.unities. 

We  may  therefore  expect  to  find  adults  suffering 
from  constipzftion  much  more  than  children,  al- 
though this  malady  often  begins  early  in  life. 
Women  are  more  subject  than  men  to  intestinal 
inactivity  and  all  the  terrible  consequences  which 
result  from  this  condition.  Westphalen  asserts  that 
four-fifths  of  all  women  suffer  from  constipation 
from  their  youth  onward,  a  statement  that  is  cor- 
roborated by  Foges,  the  eminent  specialist  of  Vienna, 

78 


THE  CAUSES  OF  CONSTIPATION  79 

and  that  few  experienced  practitioners  will  deny. 
Adults  have  been  longer  exposed  to  the  degenerative 
influences  of  civilized  life  than  have  children,  and 
the  life  of  civilized  women  is  to  a  considerable 
degree  more  highly  artificial  and  unnatural  than 
that  of  men. 

Professor  Virchow  more  than  half  a  century  ago 
called  attention  to  the  fact  that  post-mortem  exam- 
inations show  evidences  of  disease  of  the  intestines 
in  almost  every  case  of  many  hundreds  examined, 
irrespective  of  the  cause  of  death.  Indeed,  he 
declared  it  to  be  almost  impossible  to  find  an  adult 
person  whose  intestines  did  not  show  adhesions  and 
other  evidences  of  chronic  disease.  At  that  time 
the  origin  and  significance  of  these  inflammatory 
conditions  was  not  understood.  We  now  know  that 
infections  of  the  interior  of  the  intestine,  by  causing 
inflammation  of  the  intestinal  walls,  readily  extend 
to  the  outside,  giving  rise  to  inflammatory  changes 
and  adhesions.  In  these  adhesions,  located  in  various 
parts  of  the  intestine,  but  particularly  at  special 
points  noted  by  Professor  Virchow,  and  more  re- 
cently by  Dr.  Arbuthnot  Lane,  we  have  both  a 
consequence  and  a  cause  of  constipation. 

The  Rationale  of  Constipation 

To  fully  comprehend  the  influence  of  various 
habits  and  conditions  in  developing  constipation, 
it  is  necessary  to  have  in  mind  the  mechanism  of 


80  COLON   HYGIENE 

defecation  and  the  conditions  essential  to  the  normal 
colon  action.  The  several  acts  by  which  the  colon 
is  emptied  of  its  contents  may  Jdc  briefly  summarized 
as  follows : 

1.  Contraction   of   the   diaphragm  —   a    deep 
breath. 

2.  Contraction  of  the  abdominal  muscles. 

3.  Pressure  of  the  thighs  against  the  abdomen 
as  in  the  squatting  position  assumed  by  the  savage. 

4.  Reflex  contraction  of  the  abdominal  muscles. 

5.  Contraction  of  the  colon. 

6.  Relaxation  of  the  anus. 

7.  Contraction  of  the  levator-ani  muscles. 
Any  influence  which  interferes  with  a  single  one 

of  these  seven  steps  in  the  normal  process  of  defeca- 
tion may  give  rise  to  constipation,  and  when  the 
disturbing  influence  is  of  such  character  as  to  inter- 
fere with  several  factors,  the  result  is  certain  to  be 
an  extremely  obstinate  form  of  colon  inactivity. 

The  causes  of  constipation  may  become  operative 
either  before  or  during  the  action  of  defecation. 
In  order  that  normal  defecation  should  occur,  it 
is  necessary  that  fecal  matters  should  reach  the 
pelvic  colon  in  condition  to  be  expelled  from  the 
body,  and  that  the  pelvic  colon  should  be  free  to 
rise  out  of  the  pelvis,  so  that  it  may  discharge  a 
part  of  its  contents  into  the  rectum;  and  it  is  then 
essential  that  there  should  be  no  interference  with 
-iny  of  the  several  factors  which  enter  into  the 
'sormal   act   of    defecation. 


THE  CAUSES  OF  CONSTIPATION  81 

Among  the  causes  that  may  operate  to  prevent 
the  proper  preparation  of  the  bowel  for  the  act 
of  defecation  through  the  accumulation  of  the  bowel 
contents  in  the  pelvic  colon,  are  the  following: 

1.  Deficient  bulk  of  intestinal  contents.  If 
the  amount  of  the  intestinal  contents  is  too  small 
to  distend  the  pelvic  colon,  the  bowel  will  not  be 
stimulated  to  action.  This  condition  naturally 
results  during  fasting,  and  may  also  result  from 
the  use  of  a  concentrated  diet.  A  diet  largely  made 
up  of  animal  foods;  that  is,  fish,  flesh,  fowl,  eggs 
and  milk,  is  always  a  concentrated  diet,  since  these 
materials  are  almost  entirely  digested  and  absorbed, 
leaving  no  residue.  On  the  other  hand,  vegetable 
foods,  with  a  few  exceptions, — such  as  the  banana, 
potato,  fine  flour  bread,  and  polished  rice, — contain 
a  considerable  amount  of  cellulose,  which  in  human 
beings  is  indigestible. 

2.  A  spastic  or  contracted  condition  of  the  bowel 
in  the  transverse,  descending,  or  iliac  colon  may  hold 
back  the  intestinal  contents,  preventing  them  from 
reaching  the  pelvic  colon,  and  so  may  interfere  with 
normal  bowel  action.  This  condition  exists  in 
nearly  all  persons  suffering  from  colitis,  the  most 
common  seat  of  which  is  the  descending  colon. 
The  effect  may  be  almost  the  same  as  that  due  to 
organic  change,  as  from  ulcer  or  adhesions. 

3.  Adhesions,  by  interfering  with  the  normal 
contraction  movements  of  the  colon,  may  seriously 
cripple  its  function.     These  adhesions  may  be  the 


82  COLON  HYGIENE 

result  of  peritonitis  due  to  chronic  infection  of  the 
mucous  membrane  extending  through  the  wall  of 
the  bowel  to  its  peritoneal  surface.  Such  adhesions 
may  occur  between  any  part  of  the  colon  and  the 
abdominal  wall,  but  are  most  likely  to  occur  in 
the  lower  part  of  the  colon.  Adhesions  of  this  part 
of  the  colon  are  in  the  writer's  experience  very 
likely  to  be  found  present  in  cases  of  extremely 
obstinate  constipation. 

4.  Redundancy  of  the  colon  is  another  frequent 
cause  of  constipation.  The  overloaded  colon  is  grad- 
ually stretched,  until  it  may  acquire  nearly  double 
its  normal  length.  The  redundant  colon  often  be- 
comes folded  upon  itself,  and  adhesions  form,  giving 
rise  to  kinks  which  produce  mechanical  obstacles 
to  the  forward  movement  of  the  intestinal  contents. 

5.  Incompetency  of  the  ileocecal  valve,  by  pre- 
venting the  forward  movement  of  the  intestinal 
contents,  hinders  the  normal  filling  of  the  pelvic 
colon,  and  so  leads  to  constipation. 

6.  Ordinarily,  the  whole  bowel  is  not  emptied 
in  the  act  of  defecation.  The  length  of  the  colon 
is  such  that  the  residue  from  two  or  more  meals 
may  be  present  in  different  parts  of  the  intestine 
at  the  same  time.  For  example,  the  supper  residue 
may  be  passing  into  the  cecum  while  the  dinner 
residue  occupies  the  transverse  colon  and  the  break- 
fast residue  is  in  the  pelvic  colon  ready  to  be  dis- 
missed. 

The  descending  colon  is  normally  found  in  an 


THE  CAUSES  OF  CONSTIPATION  83 

empty  state.  When  the  intestinal  contents  are 
pushed  from  the  transverse  colon  over  into  the  de- 
scending colon,  they  are  not  long  retained,  as  in  other 
parts  of  the  colon,  but  pass  rapidly  down  to  the 
pelvic  colon,  which  seems  to  be  intended  by  nature 
for  a  sort  of  discharging  reservoir,  in  which  the 
fecal  matter  accumulates  until  a  sufficient  degree 
of  distention  of  the  bowel  has  been  induced  to 
stimulate  peristaltic  action. 

A  lack  of  this  distending  stimulus,  which  is  es- 
sential to  bowel  activity,  is  a  cause  of  constipation 
in  a  large  number  of  persons  whose  pelvic  colons 
have  been  over-distended.  In  such  persons  an 
extremely  bulky  diet  is  necessary  to  fill  the  pelvic 
colon  to  such  a  degree  as  to  bring  about  the  reflex 
movements  which  induce  normal  bowel  action. 

In  persons  who  are  chronically  constipated  the 
descending  colon  is  often  constantly  filled.  The 
long  contact  of  the  poisonous  fecal  matters  with 
the  mucous  membrane  gives  rise  to  infection.  This 
is  colitis.  Colitis  causes  contraction  of  the  bowel, 
thus  becoming  a  new  and  most  potent  cause  of 
constipation.  The  contraction  produced  by  colitis 
not  only  obstructs  the  bowel,  but  also  sets  up  anti- 
peristaltic movements,  thus  reversing  the  action  of 
the  bowel  and  carrying  material  back  to  the  ascend- 
ing colon  and  cecum.  Normally,  the  anti-peristaltic 
contractions  start  at  the  middle  of  the  transverse 
colon  and  do  not  involve  the  lower  half  of  the 
colon.      But  when  colitis  and  spasm   are  present, 


84  COLON  HYGIENE 

the  reverse  movement  extends  even  to  the  pelvic 
colon.  This  fact,  discovered  by  Case,  explains  the 
peculiarl}^  irregular  and  erratic  bowel  movements 
characteristic   of    colitis. 

7.  By  compression  of  the  waist,  such  as  results 
from  the  wearing  of  corsets  and  tight  dresses,  the 
action  of  the  diaphragm  is  greatly  crippled.  This 
may  be  one  reason  why  women  in  general  suffer 
from  constipation  more  than  do  men.  The  feeble  con- 
dition of  the  diaphragm  and  other  breathing  muscles, 
which  is  the  natural  result  of  neglect  of  exercise, 
produces  a  similar  effect  in  both  men  and  women. 

8.  A  feeble  and  relaxed  condition  of  the  ab- 
dominal muscles,  the  result  of  a  sedentary  life, 
and  especially  of  a  stooped  and  relaxed  posture  of 
the  body  in  sitting  or  standing,  will  necessarily 
interfere  with  both  voluntary  and  reflex  contraction 
of  these  important  muscles,  which  is  an  essential 
factor  in  normal  defecation.  WTien  the  colon  has 
been  long  over-distended  by  neglect,  and  relaxed 
by  the  long-continued  use  of  the  warm  enema,  its 
power  to  contract  is  necessarily  greatly  diminished. 
This  condition  of  the  bowel  not  only  prevents  in- 
efficient normal  defecation,  but  the  efficiency  of  the 
bowel  may  be  still  further  interfered  with  by 
adhesions  and  kinks. 

9.  Hemorrhoids,  fissures,  ulcers,  fistulse,  and 
simple  irritation  of  the  mucous  membrane  in  the 
anal  region,  may  cause  spasm  or  abnormal  tightness 
of  the  anal  muscle,  so  that  the  ordinar^^  reflex  is 


THE  CAUSES  OF  CONSTIPATION  85 

insufficient  to  cause  relaxation  of  the  muscle,  and 
it  thus  becomes  a  mechanical  obstacle  to  bowel 
movement. 

10.  The  levator-ani  muscle  frequently  becomes 
so  weakened  by  continuous  over-stretching,  as  the 
result  of  accumulation  of  hard  fecal  matters  in  the 
rectum,  that  it  loses  its  power  to  contract.  This 
condition  may  also  be  induced  by  proctitis,  a  common 
result  of  constipation. 

When  the  rectum  walls  are  thus  weakened  and 
paralyzed,  the  rectum,  instead  of  being  always  empty 
except  during  defecation,  always  contains  more  or 
less  fecal  matter,  the  constant  contact  of  which  with 
the  mucous  membrane  produces  loss  of  sensibility  and 
chronic  catarrh  or  proctitis,  and  often  gives  rise 
to  hemorrhoids,  anal  ulcer,  abscesses,  fistula  and 
local  affections. 

It  is  thus  apparent  that  in  all  cases  of  constipation 
there  is  a  definite  reason  for  intestinal  inactivity. 
In  every  case  of  really  serious  constipation — that  is, 
cases  which  are  not  relieved  by  regulation  of  diet — 
careful  inquiry  must  be  made  for  the  purpose  of 
ascertaining  the  exact  conditions  which  are  inter- 
fering with  normal  intestinal  movement,  including 
both  the  exciting  and  the  predisposing  causes  of  these 
conditions,  which  will  be  considered  at  length  in 
succeeding  pages. 

In  discussing  the  causes  of  constipation,  we  will 
consider  first  of  all  the  influence  of  habits  of  life 
upon  the  function  of  defecation,  and  will  then  notice 


86  COLON   HYGIENE 

various  morbid  conditions  in  different  parts  of  the 
alimentary  canal,  which  may  give  rise  to  constipa- 
tion. 


Habits  Which  Give  Rise  to 
Constipation 

,  In  considering  the  habits  of  life  common  among 
civilized  people  which  give  rise  to  constipation,  we 
shall  not  undertake  to  arrange  the  subject  matter 
in  the  order  of  relative  importance,  but  rather  speak 
first  of  those  which  are  most  common. 

Hasty  Eating 

Insufficient  mastication  is  a  fault  peculiar  to  civ- 
ilized men.  The  savage,  as  well  as  the  monkey 
and  all  lower  animals  that  are  provided  with  teeth 
for  grinding  food,  masticates  his  food  with  the 
greatest  thoroughness.  The  accompanying  cut  made 
from  the  lower  jaw  of  a  skull  in  the  writer's  pos- 
session, shows  the  teeth  of  an  ancient  mound  builder, 
a  Malkelkos  Indian.  The  well-worn  appearance  of 
the  teeth  affords  sufficient  evidence  of  the  thorough- 
ness with  which  they  were  used  in  grinding  the  nuts 
and  cereal  food  which  formed  the  dietary  of  these 
aborigines. 

Hasty  eating  leads  to  constipation  in  a  variety 
of  ways,  but  most  directly,  perhaps,  by  the  rapid 
introduction  into  the  intestine  of  a  large  amount  of 
imperfectly  masticated  food  material,  which  being 
slowly  digested,  undergoes  putrefaction  and  other 
changes,  by  which  the  functions  of  every  part  of  the 

87 


88  COLON  HYGIENE 

digestive  canal  to  the  colon  are  more  or  less  dis- 
turbed. As  has  been  mentioned,  the  food  is  normally 
held  back  for  three  or  four  hours  at  the  ileocecal 
valve,  to  permit  the  completion  of  intestinal  digestion 
and  absorption.  When  the  food  has  been  imperfect- 
ly chewed,  it  may  be  too  long  delayed  at  this  point. 

As  the  result  of  the  long  delay  in  the  small 
intestine,  the  food  mass  contains  too  little  water 
when  finally  passed  through  into  the  colon,  and 
is  moved  along  with  great  difficulty,  and  by  delay 
tends  to  dilatation  of  the  colon.  Under  normal  con- 
ditions the  food  does  not  remain  in  the  body  more 
than  twenty-four  hours,  but  under  the  conditions 
just  described  it  may  be  retained  for  forty-eight 
hours  or  more,  in  the  meantime  undergoing  putre- 
factive changes,  which  not  only  render  the  normal 
contents  of  the  bowel  alkaline,  and  thus  deprive 
the  bowel  of  a  normal  stimulus,  but  in  time  produce 
infection  of  the  mucous  membrane,  which  manifests 
itself  ultimately  as  chronic  colitis,  or  chronic  ap- 
pendicitis. 

Hasty  eating  is  a  fault  almost  universal  with 
the  American  people.  The  fifteen  minutes'  stop 
for  refreshments  at  the  lunch  counter  or  eating 
house,  and  the  general  spirit  of  hurry  which  is 
everywhere  manifest  in  our  bustling  communities, 
constantly  encourage,  almost  enforce,  wrong  habits 
in  eating.  If  time  is  limited,  it  would  be  far  better 
to  eat  a  smaller  quantity  and  chew  it  well,  than 
to  swallow  the  whole  amount  half  masticated. 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  89 

Excessive  Mastication 

Excessive  chewing  of  the  k)od,  to  which  the  term 
"bradyphagia"  has  been  appHed,  has  been  charged 
with  being  a  cause  of  constipation,  and  the  charge 
may  be  true.  A  person  who  follows  the  recom- 
mendation made  by  some  writers,  to  swallow  nothing 
which  cannot  be  reduced  to  liquid  in  the  mouth, 
is  sure  to  suffer  from  constipation  as  a  consequence 
of  insufficient  bulk.  Some  have  not  only  carried 
the  practice  of  chewing  to  a  great  extreme,  but  have 
reduced  the  quantity  and  bulk  of  food  to  so  low  a 
limit  that  chronic  constipation  has  been  the  natural 
result.  Constipation  is  indeed  so  common  a  result 
that  it  has  been  by  some  commended  as  one  of  the  ad- 
vantages of  thorough  mastication,  a  "food  economy" 
that  should  be  cultivated.  This  is  certainly  an  error, 
and  a  most  dangerous  one.  We  have  been  consulted 
by  a  number  of  persons  who  have  found  themselves 
suffering  from  severe  constipation  and  resulting 
autointoxication,  in  consequence  of  so  greatly  re- 
ducing the  amount  of  food  eaten,  and  especially  of 
the  amount  of  insoluble  residue,  that  there  was  too 
little  left  to  evoke  the  necessary  intestinal  move- 
ments. The  human  alimentary  canal  is  adapted 
to  somewhat  bulky  and  moderately  coarse  food- 
stuffs, and  does  not  work  well  when  such  food 
materials  are  excluded  from  the  bill  of  fare.  Bulk 
is  almost  as  necessary  as  nutriment. 

Food  should  be  chewed  sufficiently,  that  is,  until 
the  tongue  no  longer  discovers  coarse  particles. 


90  COLON  HYGIENE 

InsufHcient  Bulk 

The  alimentary  canal  of  man,  while  not  so  long 
in  proportion  to  his  size  as  that  of  the  herbivorous 
animals,  is  much  larger  and  longer  than  in  animals 
which  are  intended  to  feed  upon  a  flesh  diet.  The 
human  intestine  is  approximately  ten  times  the 
length  of  the  body,  that  is,  of  the  trunk,  which  is 
approximately  half  the  height.  The  colon  is  sac- 
culated like  the  colon  of  herbivorous  animals,  and 
like  that  of  the  higher  ape,  indicating  the  adaptation 
of  the  intestines  to  bulky  food.  Fresh  vegetables 
of  all  wholesome  sorts  are  highly  essential  to  give 
the  food  the  necessary  bulk  required  to  stimulate 
the  intestines  to  activity.  A  diet  of  bread  and  meat 
leaves  almost  no  residue  at  all  in  the  intestine. 

Fruits  and  fresh  uncooked  vegetables  are  used  far 
less  than  they  should  be  by  the  majority  of  people, 
especially  by  the  poor.  The  Russian  peasant  keeps 
his  bowels  regular  by  the  use  of  sauer-kraut,  which 
serves  him  the  same  purpose  as  the  products  of  the 
"silo"  do  the  farmer's  cattle. 

Vegetables,  especially  such  vegetables  as  carrots, 
turnips,  beets,  parsnips,  lettuce,  cabbage  and  spinach, 
contain  a  large  amount  of  cellulose,  which  is  not 
readily  digestible  by  the  human  digestive  organs. 
This  cellulose  is  highly  important  to  make  the 
nutritive  elements  of  the  food  less  concentrated 
and  to  furnish  to  the  intestines  the  necessary  stimulus 
to  cause  them  to  move  the  food  and  food  residues 
along  at  a  proper  rate. 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  91 

Nearly  all  fruits  and  most  vegetables,  especially 
that  curious  vegetable-fruit,  the  tomato,  contain 
organic  acids, — citric,  malic  and  tartaric.  The  free 
use  of  foods  containing  these  acids  is  as  wholesome 
for  man  as  for  other  frugivorous  animals.  Their 
laxative  effect  is  essential  to  maintain  a  healthy 
colon. 

Meat  Eating 

Carnivorous  animals  have  a  short  alimentary 
canal  and  a  smooth  colon.  The  movement  of  food 
stufEs  along  this  short,  smooth  passage  is  rapid. 
This  is  necessary  for  the  preservation  of  the  life  of 
the  animal,  as  undigested  remnants  of  meat  long 
retained  in  the  body  necessarily  undergo  putrefactive 
changes  with  the  production  of  ptomaines  and 
poisons  of  a  dangerous  character.  The  digestion 
of  meat  leaves  little  residue,  hence  an  animal  that 
lives  chiefly  on  meat  has  but  little  bulk  to  stimu- 
late the  bowels  to  activity,  a  condition  which  favors 
the  putrefaction  of  undigested  remnants,  and  this 
by  creating  an  alkaline  condition  of  the  intestines 
soon  develops  constipation. 

A  diet  of  fine-flour  bread  and  meat,  with  the 
usual  concomitants  of  the  ordinary  bill  of  fare, 
would  be  an  excellent  prescription  for  the  produc- 
tion of  constipation.  Within  the  last  century  there 
has  been  an  enormous  increase  in  the  use  of  flesh 
foods  in  all  civilized  countries;  and  the  use  of 
modern  milling  proccesses  has  become  almost  uni- 


92  COLON  HYGIENE 

versal.  Fine  flour  bread  and  meat  form  a  combi- 
nation that  is  productive  of  prodigious  harm,  not 
only  in  causing  constipation,  but  also  in  depriving 
the  bones  of  the  lime  salts  which  are  essential  for 
their  development  and  maintenance.  From  the 
lack  of  lime  salts  comes  decay  of  the  teeth,  and  loss 
of  the  teeth  leads  to  imperfect  mastication  of  food. 
The  increased  consumption  of  flesh,  and  the  sub- 
stitution of  fine-flour  bread  for  the  wheatmeal  of 
our  ancestors,  are  two  calamities,  the  evil  results  of 
which  upon  the  health  of  the  men  and  women  of 
the  present  generation  are  incalculably  great. 

Milk 

Within  the  last  few  years  much  evidence  has 
accumulated  to  the  effect  that  cow's  milk  is  by 
no  means  the  specially  wholesome  human  nutriment 
that  it  was  once  supposed  to  be.  Bunge,  a  great 
physiologist,  and  perhaps  one  of  the  world's  great- 
est authorities  on  foods,  goes  so  far,  indeed,  as  to 
assert  that  many  thousands  of  children  are  annually 
killed  by  feeding  on  cow's  milk;  and  many  persons 
have  learned  from  their  own  observation  that  milk 
does  not  agree  with  them.  Cow's  milk  is  excel- 
lent food  for  calves,  to  which  it  is  naturally  adapted, 
but  for  many  human  adults  it  appears  to  behave 
almost  as  a  poison.  The  probable  cause  is  the  very 
common  inability  to  digest  the  casein  of  cow's  milk. 
Personal  observations  in  a  very  large  number  of 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  93 

cases  have  convinced  the  writer  that  at  least  one- 
third,  and  probably  more  than  one-half,  of  the 
persons  suffering  from  chronic  disease  cannot  use 
cow's  milk  freely  without  more  or  less  serious 
injury.  One  of  the  prominent  symptoms  arising 
from  the  use  of  cow's  milk  is  the  production  of  a 
condition  commonly  known  as  "biliousness".  The 
tongue  becomes  coated,  there  is  a  bad  taste  in  the 
mouth,  the  breath  is  foul,  the  bowels  are  inactive, 
and  an  examination  of  the  stools  shows  the  pres- 
ence of  considerable  quantities  of  undigested  casein 
undergoing  putrefaction. 

The  free  use  of  milk  is  unknown  among  savages. 
The  writer  has  no  doubt  that  the  extensive  use  of 
milk,  under  the  mistaken  notion  that  it  is  a  spe- 
cially valuable  food  for  adults  as  well  as  for  infants^ 
is  one  of  the  active  causes  of  the  steady  increase  of 
constipation  amongst  civilized  people.  Putrefaction 
of  undigested  casein  in  the  colon  produces  an  alka- 
line condition  which  paralyzes  the  bowel  and 
encourages  conditions  by  which  the  defecating  mech= 
anism  is  in  various  ways  more  or  less  irreparably 
damaged. 

A  Bland  or  Monotonous  Diet 

Pawlow  has  shown  the  importance  of  taste  as  an 
element  in  digestion.  According  to  his  experiments, 
the  activity  of  the  stomach  begins  almost  immedi- 
ately after  food  is  taken  into  the  mouth.  The 
Intensity  of  the  gastric  activity  depends  upon  the 


94  COLON  HYGIENE 

degree  of  stimulation  of  the  gustatory  nerves.  Cash 
has  shown  by  experiments  on  dogs  that  even  the 
smell  of  food  produces  peristaltic  activity.  If  the 
food  is  not  relished,  the  stomach  does  not  produce 
"appetite  juice",  and  the  vigorous  peristaltic  move- 
ments that  are  essential  for  sound  digestion,  and  that 
are  equally  necessary  to  stimulate  movement  of  the 
intestinal  contents  all  along  the  line,  are  not  ini- 
tiated. It  must  be  remembered,  as  has  been  shown 
in  a  previous  chapter,  that  the  taking  of  food, 
although  it  has  for  its  primary  object  the  introduc- 
tion of  nutritive  material  into  the  body,  is  incident- 
ally necessary  as  a  means  of  setting  up  the  strong 
peristaltic  waves  that  push  forward  the  fecal  matters 
that  have  accumulated  in  the  colon,  causing  them 
to  pass  through  the  sphincter  which  guards  the 
upper  entrance  of  the  rectum,  and  to  set  up  the 
series  of  automatic  movements  by  which  this  waste 
and  unusable  material  may  be  removed  from  the 
body. 

In  order,  then,  that  these  two  prime  purposes 
of  eating — namely,  the  nourishment  of  the  body, 
and  the  evacuation  of  poisonous  material — should  be 
efficiently  accomplished,  it  is  necessary  that  the  food 
should  be  so  inviting  and  stimulating  to  the  senses 
which  participate  in  the  enjoyment  of  food  that 
the  digestive  activity  will  be  prompt  and  vigorous. 
A  meal  taken  without  relish  and  eaten  as  a  mere 
matter  of  routine  and  duty  does  not  accomplish 
this.     A  person  who  eats  without  appetite  is  always 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  95 

constipated.  Even  if  the  bowels  move  regularly,  the 
discharged  materials  should  have  been  got  rid  of 
twenty-four  or  forty-eight  hours  before;  there  is 
a  latent  constipation,  the  evil  results  of  which  do 
not  materially  differ  in  the  main  from  those  of 
other  forms  of  constipation,  although  likely  to  escape 
attention.  The  bill  of  fare  should  be  so  varied 
from  day  to  day  and  from  meal  to  meal,  and  the 
food  should  be  of  such  a  character,  that  each  meal 
will  be  taken  with  keen  relish.  This  is  especially 
important  for  persons  whose  lives  are  sedentary, 
and  who  on  this  account  are  more  likely  to  suffer 
from  loss  of  appetite,  and  the  constipation  which 
is  both  a  cause  and  a  consequence  of  this  difficulty. 

The  Exclusive  Use  of  Cooked  Food        ' 

While  it  is  true  that  the  cooking  of  food  in 
general  increases  digestibility,  experience  in  the 
feeding  of  both  infants  and  adults  has  clearly  shown 
that  a  diet  consisting  exclusively  of  cooked  food  is 
detrimental  both  to  digestion  and  to  general  health, 
and  may  lead  to  the  most  serious  results.  It  has, 
indeed,  been  shown  that  in  children  a  cooked  diet, 
such  as  sterilized  milk,  for  example,  may  lead  to  the 
development  of  rickets  and  general  mal-nutrition. 
Combe,  one  of  the  world's  greatest  authorities  on 
infant  feeding,  asserts  that  the  symptoms  and  injury 
from  such  a  dietary  make  their  appearance  within 
two   or   three   weeks.      The   writer's    observations 


96  COLON  HYGIENE 

have  fully  convinced  him  that  adults  as  well  as 
infants  suffer  from  this  cause.  It  has  long  been 
known  that  salt  is  not  the  exclusive  cause  of  scurvy 
in  sailors,  as  was  once  supposed ;  it  is  rather  the  lack 
of  certain  elements — enzymes  and  vitamines  found 
in  raw  foods,  many  .of  which  are  destroyed  by  the 
heat  of  cooking,  and  which  are  essential  to  good 
nutrition. 

Another  objection  to  the  exclusive  use  of  a  cooked 
diet  has  a  special  relation  to  the  subject  in  hand — 
the  fact  that  it  renders  the  cellulose  of  the  food  too 
readily  digestible  by  the  intestinal  bacteria,  so  that 
the  amount  remaixiing  is  insufficient  to  give  to  the 
intestine  the  needed  stimulus  to  movement. 

The  same  objection  also  applies  in  relation  to 
starch.  Raw  starch  is  to  a  degree  digestible  in  the 
intestine,  but  cooked  starch  is  much  more  readily 
digestible.  For  good  bowel  action,  it  is  necessary 
that  a  certain  amount  of  undigestible  starch  should 
find  its  way  into  the  colon.  Cooked  starch  is 
quickly  converted  into  sugar,  and  is  completely 
absorbed  in  the  small  intestine.  When  no  starch 
reaches  the  colon,  the  acid-forming  bacteria  which 
feed  upon  starch  and  convert  it  into  lactic  and  other 
acids,  are  not  able  to  grow;  acids  are  not  formed, 
the  intestinal  contents  become  alkaline,  with  the 
formation  of  ammonia  and  the  putrefaction  of  pro- 
tein. This  condition  results  in  a  semi-paralysis  of 
the  colon,  so  that  the  feces  are  too  long  retained, 
and  putrefaction  proceeds  still  farther. 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  97 

Foods  containing  starch  or  cellulose  should  be 
taken  every  day,  or  preferably  at  every  meal.  Among 
foods  of  this  kind  to  be  specially  recommended  are 
green  corn  fresh  from  the  garden  (uncooked), 
lettuce,  cabbage,  and  fresh  fruits  of  all  sorts,  turnips 
of  the  best  varieties,  and  even  radishes,  if  care  be 
taken  to  remove  the  acrid  rind.  Young  carrots  are 
also  relished  by  some  prepared  raw.  As  a  salad 
Cucumbers  and  raw  tomatoes  are  excellent. 

These  raw  foods  must  be  thoroughly  chewed, 
as  otherwise  they  may  cause  too  long  delay  in  the 
stomach  or  in  the  small  intestine.  The  universal 
relish  for  fresh  vegetables,  and  the  intense  craving 
for  them,  is  an  evidence  of  their  value.  These  food 
stuffs,  while  supplying  very  little  active  nutriment, 
nevertheless  furnish  the  body  with  quantities  of  cer- 
tain elements  which  modern  research  shows  to  be 
essential,  while  at  the  same  time  they  supply  neces- 
sary bulk  and  a  sufficient  amount  of  undigested 
carbohydrates  to  establish  in  the  colon  conditions 
essential  for  a  normal  activity. 

Hot  Foods  and  Drinks 

Heat  relaxes  and  paralyzes,  while  cold  stimulates. 
For  a  muscle  in  a  state  of  cramp  or  violent  contrac- 
tion, the  application  of  heat  is  the  most  efficient 
remedy.  When  food  is  taken  into  the  stomach 
active  muscular  movements  at  once  begin.  As  we 
have  seen,  these  movements  are  essential,  not  only 


98  COLON   HYGIENE 

for  churning  the  food  and  passing  it  onward  along 

the  digestive  tube,  but  also  to  move  forward  the 
contents  of  the  colon  to  the  sensitive  point  in  the 
rectum,  at  which  are  set  up  the  automatic  actions 
by  which  the  bowels  are  moved.  Heat,  whether 
taken  into  the  stomach  by  food  or  drink,  or  applied 
externally,  has  the  effect  of  weakening  these  move- 
ments. It  does  this  by  exciting  the  sympathetic 
nerves  which  hinder  or  inhibit  the  movements  ot 
the  stomach  or  intestine,  and  so  check  peristalsis. 
The  practice  of  eating  food  as  hot  as  it  can  be 
swallowed,  and  especially  of  taking  hot  drinks  at 
meals,  is  unquestionably  a  very  active  cause  of 
constipation.  If  the  food  is  held  in  the  mouth  for 
a  sufficient  length  of  time  to  permit  thorough 
mastication  and  the  proper  admixture  of  saliva,  no 
harm  will  result  from  serving  it  hot  when  necessary, 
as  it  will  be  cooled  in  the  mouth  to  body  temperature 
before  swallowing. 

Priessnitz,  the  sagacious  peasant  doctor  of  water 
cure  fame,  noted  the  unwholesome  effects  of  hot 
foods  more  than  a  century  ago.  By  experiments 
upon  pigs  he  demonstrated  that  hot  food  produced 
an  unhealthy  state  of  the  intestine.  He  accordingly 
recommended  his  patients  to  take  their  food  at  the 
natural  temperature  of  the  air,  and  the  thousands 
coming  from  every  part  of  the  civilized  world  who 
annually  ate  at  his  table  in  the  little  village  of 
Graefenberg,  hidden  among  the  forests  of  Austrian 
Silesia,  testified  to  his  success  in  the  treatment  of 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  99 

chronic  constipation  and  numerous  other  ills  which 
were  at  that  time  acknowledged  incurable  even  by 
the  best  physicians. 

Hot  foods  and  drinks  produce  a  sensation  of 
comfort  in  the  stomach  directly  after  they  are  swal- 
lowed. In  certain  forms  of  indigestion  this  efFect  of 
heat  is  particularly  noticeable.  In  these  cases,  how- 
ever, temporary  comfort  is  obtained  only  at  the 
expense  of  the  later  serious  disadvantages  of  the 
constipating  effect  of  such  a  diet. 

A  Meager  or  Low  Diet 

Many  persons  suffer  from  constipation  because 
they  do  not  eat  enough.  They  are  in  constant  fear 
of  overloading  the  stomach  and  bowels,  and  the 
consequence  is  that  these  organs  lack  sufficient  work 
to  stimulate  them  to  proper  activity.  The  writer 
has  many  times  surprised  such  patients  by  the  pre- 
scription of  a  meal  two  or  three  times  as  large  as 
was  being  taken.  The  patient  has  usually  found 
that  he  suffers  no  harm  from  his  large  meal,  and  is 
able  to  digest  it  without  difficulty,  and  has  also 
experienced  a  notable  improvement  in  bowel  action. 
The  peristaltic  waves  which  move  the  food  along 
in  the  stomach  and  small  intestine  and  the  feces  in 
the  colon,  are  set  up  by  reflex  action  excited  by  the 
food  itself;  that  is,  contact  of  the  food  with  the 
mucous  membrane  of  the  stomach  and  intestine  ex- 
cites certain  nerves  by  which  the  muscles  are  stimu- 


100  COLON  HYGIENE 

lated  to  activity.  This  action  may  be  likened  to 
the  ringing  of  a  bell  in  response  to  the  touch  of  an 
electric  button,  or  the  starting  of  an  electric  fan 
by  the  moving  of  a  switch.  When  taken  into  the 
stomach,  food  by  its  contact  with  the  mucous  mem- 
brane sets  in  operation  the  food  motor  that  operates 
in  the  upper  part  of  the  digestive  canal  to  carry 
the  food  stujffs  along  from  one  part  of  the  digestive 
tube  to  another  and  in  the  lower  part  to  transport 
rubbish  and  refuse  to  the  place  of  exit. 

The  degree  of  this  movement  depends  upon  the 
amount  of  stimulation,  while  the  amount  of  stimu- 
lation depends  largely  upon  the  bulk  of  food  taken. 
This  stimulating  effect  is  produced  not  only  in  the 
stomach,  but  in  the  small  intestine. 

It  is  evident,  then,  that  for  vigorous  stimula- 
tion of  the  intestine,  such  as  is  needed  to  bring  about 
the  evacuation  of  the  colon,  a  full  meal  must  be 
more  effective  than  a  meagre  one.  This  is  one 
important  reason  why  the  taking  of  food  at  regular 
and  not  too  frequent  intervals  is  favorable  to  regular 
bowel  action.  A  small  amount  of  food  taken  at 
frequent  intervals  may  not  at  any  time  set  up  a 
sufficient  degree  of  stimulus  to  give  the  bowel  the 
impulse  required. 

People  who  "diet"  do  themselves  great  injury 
often  by  too  great  restriction  of  the  bill  of  fare, 
both  in  quantity  and  variety  of  food.  A  food  that 
the  patient  imagines  to  be  constipating  or  otherwise 
harmful  is  generally  found  to  have   the  expected 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  101 

result.  Thus,  item  after  item  the  food  is  discarded, 
until  the  bill  of  fare  is  reduced  to  a  few  articles 
which  are  usually  taken  without  relish  and  with 
more  or  less  apprehension  of  injury.  Such  patients 
might  far  better  pay  no  attention  to  diet  whatever; 
they  would  run  far  less  risk  of  injury  by  taking 
whatever  the  appetite  craved. 

In  this  connection  it  should  be  noted,  however, 
that  in  increasing  the  amount  of  the  food  intake, 
the  increase  should  usually  be  in  bulk  rather  than 
in  food  value.  The  added  bulk  should  consist  of 
such  foodstuffs  as  lettuce,  celery,  turnips,  tomatoes, 
greens,  fresh  fruits  and  other  articles  which  give 
large  bulk  with  little  nourishment. 

Constipating  Diets 

Nurses,  and  perhaps  physicians  also,  sometimes 
unwittingly  do  their  patients  great  harm  by  re- 
stricting the  diet  to  bland  or  liquid  foods,  which 
are  often  taken  vdthout  relish,  and  which  on  this 
account,  as  well  as  by  lack  of  bulk,  tend  in  the 
highest  degree  to  promote  intestinal  inactivity  and 
obstinate  constipation.  A  diet  like  this  naturally 
necessitates  the  use  of  artificial  means  for  moving 
the  bowels.  Many  a  patient  owes  the  beginning  of 
his  constipation  to  such  a  course  of  dieting  during 
temporary  illness.  Milk,  which  has  been  so  much 
relied  upon  as  a  sick-room  diet,  is  particularly  objec- 
tionable in  a  very  large  number  of  cases,  for  reasons 
which  have  already  been  given.     Buttermilk  is  pre- 


102  COLON  HYGIENE 

ierable,  because  of  the  lactic  acid  it  contains,  while 
its  value  is  greatly  increased  by  the  addition  of  malt 
sugar  or  milk  sugar,  and  wheatmeal  porridge,  or  a 
porridge  of  corn  meal  or  oatmeal  made  v/ith  an 
addition  of  wheat  bran.  Fruit  juices  are  extremely 
useful.  There  are  very  few  cases  in  which  such 
iresh  things  as  lettuce  and  scraped  apple  and  other 
raw  fruits  may  not  be  taken  with  great  advantage 
as  well  as  vegetable  purees.  The  danger  of  the 
use  of  solid  food  in  these  cases  is  purely  imaginary, 
if  care  is  taken  to  exclude  meat,  fried  foods,  and 
indigestible  combinations.  Thorough  chewing  of 
the  food  is  of  course  essential. 

The  dietaries  generally  prescribed  in  certain  forms 
of  chronic  disease,  and  considered  to  be  essential, 
are  often  highly  constipating.  This  is  particularly 
true  in  the  meat  treatment  for  diabetes.  Constipa- 
tion is  nearly  alwa5^s  found  present  in  persons  suf- 
fering from  this  malady.  It  will  always  be  found, 
indeed,  that  constipation  existed  before  the  appear- 
ance of  sugar  in  the  urine.  The  writer  has  no  doubt 
that  chronic  constipation  is  one  of  the  most  prolific 
causes  of  the  rapid  increase  of  diabetes  in  all  civilized 
communities.  The  statistics  gathered  in  the  United 
States  Census  Bureau,  show  a  death  rate  from  this 
source  nearly  ten  times  as  great  as  twenty  years  ago. 
As  has  been  pointed  out  already,  meat,  which  is 
usually  the  staple  article  prescribed  for  diabetic 
patients,  leaves  little  residue,  while  at  the  same  time 
promoting  putrefaction  in  the  colon,  thus  establish- 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  103 

ing  conditions  which  of  necessity  favor  constipation. 
This  difficulty  may  be  entirely  overcome  by  the 
free  use  of  green  vegetables,  bran,  and  vegetable 
protein  or  pure  gluten. 

In  the  dietetic  treatment  of  hyper-acidity,  and 
especially  of  ulcer  of  the  stomach  and  the  duodenum, 
the  usual  prescription  is  of  such  a  character  as  to 
cause  constipation,  v^^hich  in  turn  leads  to  intestinal 
toxemia  and  to  a  relapse  later  on.  The  withholding 
of  bulk-forming  food  is  by  no  means  so  essential  in 
these  cases  as  has  been  supposed;  the  essential  thing 
is  to  avoid  the  stimulation  of  the  gastric  secretion  by 
flesh  foods  and  the  extractives  of  meat  that  are  found 
in  bouillon,  broths  and  meat  extracts.  These  sub- 
stances powerfully  stimulate  the  gastric  secretion, 
and  thus  aggravate  and  perpetuate  the  ulceration. 
They  also  produce  autointoxication,  which  encour- 
ages hyper-acidity  and  tends  to  the  formation  of 
ulcer.  Carefully  prepared  vegetable  purees  may 
usually  be  given  in  these  cases  at  least  after  the  first 
few  days,  not  only  without  injury,  but  even  with 
much  benefit,  thus  preventing  the  constipation  which 
is  certain  to  result  from  the  bland,  liquid  diet. 

Fasting 

Fasting,  which  is  sometimes  prescribed  as  a  reme« 
dial  measure,  necessarily  leads  to  constipation,  unless 
some  preventive  method  is  adopted.  The  use  of  the 
enema  is  not  sufficient.  Washing  out  of  the  colon 
can  do  nothing  more  than  remove  materials  which 


104  COLON  HYGIENE 

have  been  deposited  in  it  from  the  small  intestine; 
and  in  fasting,  the  small  intestine  as  well  as  the 
stomach  is  in  a  state  of  complete  inactivity.  Bile, 
mucus  and  other  secretions,  as  well  as  poisonous 
excretions  from  the  blood,  are  accumulating  from 
day  to  day,  but  there  is  no  peristaltic  movement  to 
carry  them  onward,  because  no  food  is  taken  into 
the  stomach.  From  these  facts  it  is  evident  that 
absolute  fasting,  except  when  made  necessary  by 
some  intestinal  trouble  or  other  equally  imperative 
exigency,  is  rarely  likely  to  prove  beneficial.  As  a 
general  measure  for  purifying  the  blood,  removing 
uric  acid,  or  producing  tissue  renovation,  it  is  never 
required.  The  prodigious  claims  that  have  been 
made  for  fasting  as  a  means  of  physical  regeneration, 
are  in  the  highest  degree  misleading.  Not  a  few 
people  have  done  themselves  irreparable  damage  by 
a  prolonged  fast.  The  benefit  derived  from  fasting, 
except  when  made  necessary  by  a  surgical  operation, 
hemorrhage  from  the  stomach  or  bowels  or  some 
other  emergency,  is  due  to  the  withholding  of  pro- 
tein and  fats,  so  that  the  body  has  an  opportunity 
to  clear  itself  of  "cinders"  and  other  waste  and 
toxic  matters  derived  from  foods  rich  in  protein, 
especially  meat  and  eggs.  All  these  benefits  may 
be  obtained  by  the  exclusive  use  of  juicy  fruits  for 
a  limited  period,  or  better  still,  by  the  use  of  fruit 
of  some  kind  with  bran  and  some  green  vegeta- 
ble, such  as  lettuce.  By  this  means  the  food  tube 
is  supplied  with  the  bulk  necessary  to  maintain  its 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  105 

rhythmical  action.  The  acids  and  sugars  of  fruits 
are  active  in  the  same  direction,  while  at  the  same 
time  furnishing  the  body  with  the  necessary  fuel 
to  maintain  animal  heat,  and  support  its  activities, 
so  that  it  is  not  compelled  to  feed  upon  itself,  as 
certain  animals  when  starving  bite  and  tear  their 
own  flesh,  and  suck  their  own  blood. 

The  injury  to  which  persons  subject  themselves 
by  a  long  fast  is  similar  to  that  resulting  from  a 
long  fever;  the  conditions  are  really  very  similar. 
The  appetite  of  the  fasting  person  disappears  on 
the  third  or  fourth  day,  just  as  does  that  of  the 
fever  patient,  and  from  the  same  cause,  namely,  the 
saturation  of  the  tissues  with  toxins.  In  the  case 
of  a  fasting  person,  the  result  of  the  absorption  of 
poisons  from  the  putrefying  materials  stored  up  in 
the  inactive  colon — foul  breath  and  coated  tongue 
■ — is  evidence  of  this  autointoxication,  and  not  of 
a  process  of  body  purification.  The  foul  breath  and 
coated  tongue  are  the  result  of  a  growth  of  bac- 
teria in  the  mouth  and  the  intestines,  which  is  en- 
couraged by  the  lowered  vital  resistance  resulting 
from  abstinence.  The  clearing  of  the  tongue  that 
occurs  in  many  cases  in  from  two  to  four  weeks,  is 
likewise  comparable  to  the  clearing  of  the  tongue 
in  typhoid  fever,  in  about  the  same  time,  which  re- 
sults from  the  development  of  immunity  against  the 
bacteria  and  bacterial  poisons  to  which  the  body  is 
exposed.  In  the  case  of  the  fasting  person,  clearing 
of  the  tongue  may  be  induced  by  the  taking  of  food. 


106  COLON  HYGIENE 

The  coated  tongue  does  not  occur  in  a  "protein" 
fast,  such  as  has  been  above  described. 

Obesity 

In  the  treatment  of  obesity  not  due  to  disease 
of  the  glands  of  internal  secretion,  restriction  of 
the  quantity  of  food  is  essential;  unless  care  is 
taken,  this  naturally  leads  to  constipation — a  very 
common  result  of  dieting  to  reduce  flesh.  This 
effect  of  reduced  diet  is  aggravated  by  the  sweating 
which  results  from  the  hot  baths  administered,  as 
well  as  from  the  vigorous  exercise  required.  Con- 
stipation may  be  avoided  in  these  cases  by  not  di- 
minishing the  bulk  of  the  food  intake  while  re- 
ducing its  food  value.  Indeed,  it  is  an  advantage 
to  increase  the  bulk.  The  free  use  of  green  vege- 
tables is  especially  indicated  in  obesity,  as  a  means 
of  preventing  constipation. 

Condiments 

Mustard,  pepper,  pepper  sauce,  cayenne,  capsi- 
cum, horseradish,  and  the  whole  list  of  hot,  irritat- 
ing substances  which  are  frequently  added  to  food 
as  seasoning,  having  no  food  value  in  themselves, 
are  active  causes  of  constipation.  These  substances 
produce,  at  first  irritation,  and  later  on  catarrh  of 
the  stomach  and  intestines,  leading  to  gastritis  en- 
teritis, and  colitis,  and  ultimately  to  degeneration 
of  the  gastric  glands.     The  consequence  is  loss  of 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  107 

the  normal  reflex  activity,  to  which  the  peristaltic 
movements  are  due.  But  the  vi^orst  effects  of  con- 
diments are  to  be  seen  in  the  lovi^er  part  of  the  small 
intestine  and  in  the  colon.  Condiments  being  in- 
digestible, become  more  and  more  concentrated  as 
the  food  substances  with  which  they  are  eaten  are 
absorbed,  and  hence  their  effects  are  seen  in  a  very 
pronounced  degree  at  the  extreme  lower  end  of  the 
small  intestine,  and  in  the  colon  where  the  food 
residues  accumulate  before  passing  on  to  the  cecum 
through  the  ileocecal  valve.  When  the  irritating 
mass  is  pushed  through  the  ileocecal  valve,  each 
successive  portion  falls  at  once  upon  the  floor  of 
the  cecum,  so  that  this  small  area,  to  which  is  at- 
tached the  appendix,  receives,  so  to  speak,  the  con- 
centrated fire  of  these  enemies  of  good  digestion. 
The  resulting  irritation  in  the  meantime  results  in 
infection,  upon  which  follows  colitis,  and  not  in- 
frequently acute  and  chronic  appendicitis,  affec- 
tions which  are  both  a  consequence  of  chronic  con- 
stipation. 

The  concentrated  residues  of  the  food  stuffs, 
including  the  indigestible  particles  of  mustard^ 
pepper,  or  other  condiment  taken  with  the  food, 
brought  in  contact  with  the  rectum  cause  chronic 
catarrh;  hemorrhoids  develop  together  with  ulcers^ 
fissures,  and  abscesses,  followed  by  fistulae,  and  the 
way  is  prepared  for  tuberculosis  and  cancer. 

In  India,  especially  in  Ceylon,  and  also  in  Mex- 
ico,  countries   in  which  curries  and  hot,   peppery 


Lj^ 


108  COLON  HYGIENE 

sauces  are  used,  gastric  catarrh,  constipation  and 
hemorrhoids  are  almost  universal  among  those  ad- 
dicted to  the  use  of  these  pernicious  food-poisons.. 

Irregular  Meals 

When  the  meals  are  not  taken  regularly,  the 
rhythmic  peristaltic  impulse  by  which  the  feces  are 
pushed  forward  from  the  colon  into  the  rectum  is 
lacking.  If  for  example,  a  person's  habit  is  to 
move  the  bowels  immediately  after  breakfast,  and 
the  breakfast  is  not  taken,  the  bowels  will  not 
move,  or  if  a  movement  occurs,  it  will  be  incom- 
plete; instead  of  complete  emtying  of  the  colon  be- 
low the  splenic  flexure,  which  occurs  in  a  normal 
movement  of  the  bowels,  only  the  pelvic  loop 
will  be  emptied;  and  fecal  matters  remain  in  other 
sections  of  the  colon.  After  the  next  meal,  the 
stimulus  may  be  sufficient  to  empty  the  colon  com- 
pletely; but  if  the  irregularity  is  frequently  re- 
peated the  normal  rhythm  of  the  bowels  will  be  in- 
terrupted. The  forward  movement  of  food  stuffs 
in  the  small  intestine  is  continuous  while  digestion 
is  going  on;  but  the  movement  in  the  large  intes- 
tine is  more  or  less  intermittent.  If  a  meal  is  taken 
when  the  pelvic  colon  is  loaded,  the  stimulus  of 
the  meal  will  cause  the  pelvic  colon  to  contract 
and  push  forward  a  portion  of  its  contents  into  the 
rectum.  The  feces  in  the  rectum  will  excite  the 
defecating  center,  and  thus  set  up  the  automatic 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  1 0^ 

action  by  which  a  movement  of  the  bowel  is 
effected. 

If  a  meal  is  taken  at  a  time  when  the  feces 
have  not  reached  the  pelvic  colon,  manifestly  no 
movement  of  the  bowels  can  occur,  and  a  general 
contraction  of  the  colon  by  which  its  contents  are 
discharged  does  not  take  place.  If,  on  the  other 
hand,  no  meal  is  taken  at  a  time  when  the  pelvic 
colon  is  filled,  the  movement  must  be  delayed  until 
the  next  meal  is  taken,  or  perhaps  until  some  un- 
usual straining  movement  or  exercise  serves  to 
crowd  out  some  of  the  fecal  matter  from  the  colon 
into  the  rectum.  If  the  fecal  matters  retained  in 
the  pelvic  colon  become  too  dry  to  be  readily 
moved  by  normal  stimuli,  a  laxative  or  an  enema 
becomes  necessary.  In  many  cases,  this  is  the  be- 
ginning of  chronic  constipation;  a  few  repetitions 
may  be  sufficient  to  create  a  latent  constipation  in 
which  the  bowel  movements  are  always  twenty- 
four  or  forty-eight  hours  behind  time. 

Since  bowel  movement  depends  so  largely  upon 
the  stimulus  derived  from  eating,  it  is  evident  that 
regularity  of  bowel  movement  depends  upon  regu- 
larity of  eating. 

If  a  full  meal  cannot  be  taken,  some  fresh  fruit, 
as  an  apple  or  two,  or  a  couple  of  oranges,  may 
serve  the  purpose  to  maintain  the  normal  rhythm. 
When  strong  stimulation  of  the  colon  is  needed 
a  hran  biscuit  may  be  added  with  advantage,  to- 
gether with  a  dose  of  paraffin. 


no  COLON  HYGIENE 

Tea  and  Coffee 

Tea  and  coffee  contain  two  substances  the 
poisonous  effects  of  which  are  well  known,  viz: 
caffein,  a  nerve  poison  practically  identical  with 
uric  acid,  and  tannin,  an  astringent  well  known 
as  one  of  the  constituents  of  oak  bark  and  many 
other  vegetable  substances.  A  cup  of  "good" 
coffee  contains  four  grains  of  caffein  and  two  of 
tannin.  There  is,  in  fact,  nearly  three  times  as 
much  uric  acid  in  a  cup  of  coffee,  in  the  form  of 
caffein,  as  in  an  equal  quantity  of  urine.  The  ef- 
fect of  tannin  upon  animal  tissues  is  well  shown 
in  the  process  of  tanning,  by  which  animal  skins 
are  converted  into  leather.  Tannin  is  an  active 
poison  to  the  mucous  membrane  of  the  stomach 
and  intestines;  it  not  only  interferes  with  the  di- 
gestive processes,  but  it  produces  changes  in  the 
mucous  membrane  by  which  its  power  to  respond 
to  the  delicate  impressions  made  by  the  food  is 
lessened.  The  result  is  diminished  intestinal  move- 
ment and  constipation. 

Everyone  is  familar  with  the  use  of  astringent 
or  tannin-containing  remedies  in  diarrhea.  How- 
ever beneficial  tannin  may  be  in  cases  in  which  the 
bowels  are  abnormally  active,  certainly  its  effects 
are  nothing  but  pernicious  when  habitually  used. 
The  average  civilized  man  requires  stimulation  of 
his  food  tube  rather  than  the  use  of  substances 
which  produce  a  paralyzing  effect. 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  1 1 1 

Insufficient  Fluid 

Most  persons  who  suffer  from  constipation  ha- 
bitually drink  too  little  water.  Women  drink  less 
than  men.  It  is  difficult  to  account  for  this  scanty 
use  of  a  necessary  of  life,  which  costs  little  and  is  of 
such  inestimable  value  to  the  body.  Water  is  far 
more  immediately  necessary  for  the  support  of  life 
than  is  food.  A  man  may  live  six  weeks  or  two 
months  without  tasting  food  in  any  form,  but  a 
few  days  at  the  most  is  the  limit  of  human  life 
without  water.  The  consequence  of  a  scanty  use 
of  water  is  abnormal  dryness  of  the  feces,  which 
delays  their  passage  through  the  lower  colon,  and 
often  causes  an  actual  stoppage  in  the  pelvic  colon 
or  the  rectum. 

Persons  who  sweat  much,  either  as  the  result  of 
hot  weather,  vigorous  exercise,  or  hot  baths,  are 
likely  to  suffer  from  constipation,  unless  special 
care  is  taken  to  supply  the  body  with  water  suffi- 
cient to  make  good  the  loss.  The  skin  ordinarily 
throws  off  as  perspiration  an  ounce  and  a  half  of 
water  each  hour,  or  more  than  a  quart  in  twenty- 
four  hours.  By  active  exercise  or  sweating  baths, 
this  amount  may  be  increased  to  thirty  or  forty 
ounces  in  an  hour.  The  kidneys  excrete  two  to 
three  pints  daily.  It  is  evident,  then,  that  care 
must  be  exercised  to  replace  the  water  that  is  lost 
through  the  skin  and  kidneys. 

In  diabetes  there  is  a  great  loss  of  water  through 


112  COLON  HYGIENE 

the  kidneys.  This  also  must  be  made  up  by  drink- 
ing. If  these  losses  are  not  made  good,  the  thirsty 
tissues  will  absorb  as  much  water  as  possible  from 
the  feces,  thus  causing  hardening  and  retention  in 
the  lower  bowel. 

Scanty  and  highly  colored  urine  is  an  evidence 
that  the  tissues  are  in  need  of  water.  Dryness  of 
the  skin  often  testifies  to  the  same  need. 

Water  should  be  taken  in  proper  quantity  ir- 
respective of  thirst.  It  may  be  made  palatable  by 
the  addition  of  fresh  fruit  juices. 

For  the  average  person  a  good  plan  is  to  take 
a  couple  of  glasses  of  water  on  rising,  and  the  same 
amount  before  retiring  at  night.  A  glassful  should 
be  taken  half  an  hour  before  dinner  and  supper, 
and  an  equal  amount  two  hours  after  eating.  The 
free  use  of  oranges  or  orange  juice,  and  of  other 
juicy  fruits,  serves  the  same  purpose  as  water  drink- 
ing, to  the  extent  of  the  liquid  which  they  supply. 

Persons  suffering  from  obesity  or  diabetes  are 
sometimes  restricted  in  the  drinking  of  water,  with 
the  result  that  constipation  is  produced,  if  this  con- 
dition does  not  already  exist.  This  should  never 
be  done. 

In  all  cases  in  which  there  is  a  tendency  to  dry- 
ness of  the  stools,  water  should  be  taken  in  increased 
quantity.  It  is  important  in  such  cases  also  to  di- 
minish the  amount  of  salt  eaten.  The  addition  of 
salt  to  the  food  creates  thirst  for  water  to  dissolve 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  1 13 

it  and  to  aid  in  its  elimination  through  the    skin 
and  the  kidneys. 

Children  as  well  as  adults  need  much  more 
water  than  they  are  usually  given.  Meat  eaters 
and  those  who  use  salt  freely  require  a  much  larger 
amount  of  water  than  do  those  who  adhere  to  a  low 
protein  dietary  and  who  use  little  salt. 

Irregular   Sleep 

The  resumption  of  bodily  activity  on  rising  in 
the  morning  is  one  of  the  important  means  by 
which  the  bowels  are  made  to  act  with  regularity, 
by  stimulating  the  colon  to  empty  a  portion  of  its 
contents  into  the  rectum.  When  the  hours  of 
sleep  are  irregular,  and  especially  when  insufficient 
time  is  devoted  to  sleep,  this  physiological  stimulus 
is  lacking,  and  constipation  may  be  one  of  the  evil 
consequences  resulting.  Loss  of  sleep  causes  loss 
of  tone  in  the  intestinal  muscles,  as  well  as  ot 
general  muscular  tone,  and  also  lack  of  appetite, 
thus  diminishing  the  normal  stimuli  to  bowel  move- 
ment, and  so  easily  leading  to  constipation.  Even 
when  the  bowels  do  not  move  soon  after  rising, 
the  stimulus  of  rising  after  a  good  night's  rest  at 
least  aids  in  the  filling  of  the  pelvic  loop,  which 
then  only  requires  the  stimulus  of  breakfast  to 
cause  a  normal  bowel  action.  Regularity  of  sleep 
is  almost  or  quite  as  necessary  for  regular  bowel 
movement  as  is  regularity  of  meals. 


114  COLON  HYGIENE 

Incorrect  Breathing 

A  child  does  not  have  to  be  taught  to  breathe. 
It  breathes  instinctively  and  hence  correctly,  for 
all  instinctive  movements  are  physiologically  and 
hence  correctly  performed.  But  the  breathing 
muscles  are  voluntary  muscles,  and  hence  may  be 
controlled  by  the  vi^ill.  This  fact  permits  modifi- 
cations of  the  act  of  breathing,  w^hich  may  or  may 
not  be  physiological.  Unfortunately,  the  condi- 
tions of  civilized  life  are  such  as  lead  to  serious 
perversions  of  the  breathing  process.  Normally, 
w^hen  air  is  inhaled  the  v^^hole  chest  is  enlarged,  but 
the  chief  movement  is  at  the  lower  sides  of  the 
chest.  This  broadening  of  the  chest  at  its  lowest 
part  stretches  the  diaphragm  and  thus  gives  it  an 
opportunity  to  exert  its  greatest  force.  Its  form  be- 
ing arched,  this  is  highly  important.  If  its  ends 
are  held  in  place,  the  top  of  the  arch  can  descend 
only  a  little,  and  while  breathing  is  ineffective,  the 
lungs  being  imperfectly  expanded,  the  compression 
of  the  abdominal  organs  is  equally  inefficient.  The 
diaphragm,  it  must  be  remembered,  is  a  double  act- 
ing pump.  It  creates  a  suction  in  the  chest,  while 
at  the  same  time  it  produces  pressure  in  the  abdo- 
men. If  its  work  is  imperfectly  done  in  one  direc- 
tion, it  fails  equally  in  the  other. 

The  compressing  movements  produced  by  the 
diaphragm  at  each  inspiration  are,  when  efficient, 
of  great  service  in  assisting  the  movements  of  the 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  1 15 

food  along  the  alimentary  tube.  Acting  upon  the 
stomach,  which  lies  just  beneath  it,  the  diaphragm 
churns  the  food  and  aids  in  pushing  it  along  into 
the  intestine.  Acting  upon  the  colon,  which  on  the 
left  side  lies  in  contact  with  it,  the  diaphragm  ren- 
ders great  assistance  in  helping  to  push  the  food 
along  toward  the  rectum. 

But  it  is  especially  in  the  act  of  defecation  that 
the  action  of  the  diaphragm  is  important.  The 
very  first  step  in  the  process  of  unloading  the  bowel 
is  in  the  sinking  of  the  colon  by  a  very  deep 
breath.  If  the  sides  of  the  chest  are  compressed 
by  belts  or  a  corset,  so  that  they  cannot  expand, 
the  diaphragm  cannot  descend  more  than  a  short 
distance,  and  its  action  is  inefficient.  As  a  result, 
the  fecal  matters  stored  up  in  the  descending  and 
pelvic  colon  are  not  pushed  onward  to  the  rectum, 
and  the  bowel  is  only  partially  emptied.  Thorough 
natural  bowel  movement  is  not  possible  without 
free  and  vigorous  movement  of  the  diaphragm. 

So,  too,  if  the  diaphragm  is  weak  because  of  ha- 
bitual shallow  breathing,  the  result  of  a  bad  posi- 
tion in  sitting  at  work  or  study,  the  same  result 
follows.  A  position  which  hampers  the  move- 
ments of  the  chest  thus  leads  to  constipation. 

The  ordinary  house  chair,  especially  the  rock- 
ing chair  and  easy  chairs  in  general,  train  the  body 
in  unhealthy  attitudes  and  compel  shallow  breath- 
ing. When  the  chest  is  depressed,  as  when  sitting 
in   a  hollow-backed   chair,   the   abdominal  muscles 


116  COLON  HYGIENE 

are  relaxed,  and  the  diaphragm  cannot  act  well. 
There  can  be  no  compression  of  the  abdominal 
viscera  without  a  tense  condition  of  the  abdominal 
muscles.  In  most  constipated  persons  these  mus- 
cles are  so  relaxed  and  flabby  that  they  render  lit- 
tle service.  The  colon  in  such  cases  is  compressed 
so  feebly  in  defecation  that  it  is  never  properly 
emptied  except  when  the  stools  are  made  fluid  by 
a  laxative  or  by  an  enema. 

When,  on  the  other  hand,  the  chest  is  raised,  as 
shown  in  the  accompanying  cut,  the  abdominal  mus- 
cles are  stretched,  they  are  thus  made  tense,  and  the 
colon  is  kept  under  constant  pressure,  by  which  its 
contents  are  moved  along  at  the  proper  rate;  and 
when  defecation  occurs,  these  tense,  well-developed 
muscles  are  ready  to  do  their  necessary  part  of  the 
work 

Probably  the  majority  of  sedentary  men  and 
most  civilizd  women  spend  the  greater  part  of 
their  lives  under  conditions  which  induce  imperfect 
breathing  and  lead  to  weakness  of  the  abdominal 
muscles,  and  so  to  constipation. 

When  we  consider  how  universal  among  civilized 
women  is  the  practice  of  compressing  the  waist 
by  corsets  or  bands,  we  find  a  ready  explanation  of 
the  fact  that  four-fifths  of  them  suffer  all  their  lives 
from  constipation,  while  a  large  proportion  suffer 
more  or  less  from  disorders  peculiar  to  their  sex 
which  are  by  many  supposed  to  be  a  necessary  bur- 
den laid  upon  them,  and  an  inevitable  consequence 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  1 1 7 

of  femininity  but  are  really  due  to  causes  which 
might  be  easily  avoided. 

Deficient  Exercise 

The  relation  between  exercise  and  breathing  and 
the  necessity  for  vigorous  and  untrammeled  action 
of  the  diaphragm  have  been  already  referred  to  in 
the  preceding  paragraphs.  Exercise  promotes 
bowel  action,  not  only  by  aiding  respiration  and  in- 
ducing vigorous  movements  of  the  diaphragm,  but 
by  calling  into  strong  action  the  muscles  of  the 
abdomen,  and  by  raising  the  general  muscular  tone 
of  the  body. 

The  excellent  effects  that  walking  has  upon 
bowel  activity  are  well  known.  Riding  is  also  of 
great  advantage  in  the  same  way.  These  exer- 
cises, as  well  as  many  others,  mechanically  stimu- 
late the  colon  as  well  as  all  parts  of  the  intes- 
tinal tract,  by  communicating  to  it  a  continued 
series  of  slight  shocks,  by  which  reflex  movements 
are  excited.  The  active  play  of  children  is  as 
necessary  to  maintain  proper  bowel  action  as  for 
muscular  development.  The  movements  of  skip- 
ping, hopping,  jumping,  are  especially  useful,  be- 
cause they  induce  sudden  vigorous  contractions  of 
the  abdominal  muscles,  and  vigorous  diaphragm 
movements  by  which  the  colon  is  compressed  and 
stimulated.  The  folk  dancing  of  the  middle  ages, 
which  has  been  revived  in  recent  years,  is  for  the 


118  COLON  HYGIENE 

above  reasons  to  be  highly  commended  as  a  health 
measure.  It  is  important,  however,  to  make  a  clear 
distinction  between  the  varied  and  vigorous  move- 
ments of  the  folk  dance,  in  simple  dress  and  under 
wholesome  conditions,  and  the  monotonous  and  re- 
strained movements  of  the  social  dance,  in  full 
dress  and  under  conditions  always  physically,  and 
not  infrequently  morally,  unwholesome. 

Those  whose  occupations  are  such  as  to  give 
them  plenty  of  exercise  are  fortunate  in  being  able 
to  lead  lives  which  in  large  measure  conform  to 
natural  requirements.  Such  persons  never  need 
suffer  from  constipation  if  they  eat  proper  food, 
drink  an  abundance  of  water — at  least  three  to 
five  pints  daily — and  take  care  to  give  the  bowels 
an  opportunity  for  movement  after  each  meal,  and 
promptly  whenever  there  is  a  "call"  for  evacua- 
tion. 

Those  who  are  compelled  to  lead  sedentary  lives, 
and  especially  women,  whose  lives  are  nearly  always 
more  or  less  sedentary  in  character,  must  take  daily 
and  regular  exercise  of  a  sort  calculated  to  benefit 
the  bowels  if  they  would  escape  the  evils  of  consti- 
pation and  its  secondary  results.  Some  of  the  special 
exercises  which  have  been  shown  by  experience  to 
be  of  greatest  service  in  combating  constipation 
will  be  described  in  a  subsequent  chapter.  The  ex- 
ercises of  greatest  value  are  those  which  strengthen 
the  abdominal  muscles.  A  spring  abdominal  sup- 
porter will  usually  render  great  service  (page  298). 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  1 1^ 

Resisting  the  "Call" 

The  practice  of  resisting  the  "call"  of  Nature 
to  discharge  from  the  body  accumulated  wastes  and 
rubbish  is  almost  universal  among  civilized  people, 
as  the  result  of  refinement  of  manners  and  modesty 
which  lead  to  the  concealment  of  certain  animal 
functions  as  much  as  possible.  That  this  is  the 
result  of  what  is  commonly  called  false  modesty 
cannot  be  denied,  and  yet  there  are  few  who  would 
desire  that  this  so-called  false  modesty  should  be 
altogether  laid  aside.  It  is  important,  however, 
that  every  person,  children  as  well  as  adults,  and 
at  a  very  early  age,  should  be  fully  instructed  re- 
specting the  evil  results  of  resisting  and  thus  thwart- 
ing one  of  the  most  important  of  the  bodily  func- 
tions. 

The  "call"  signifies  that  the  pelvic  colon  is  full 
of  feces,  and  that  a  sufficient  amount  of  fecal  matter 
has  been  pushed  down  into  the  rectum  to  arouse  the 
center  of  defecation  and  cause  it  to  set  in  operation 
the  automatic  processes  concerned  in  bowel  move- 
ment. The  colon  is  contracting,  and  there  is  a 
tendency  for  the  anus  to  relax,  which  must  be 
forcibly  resisted  to  prevent  immediate  discharge  of 
feces.  The  feces  are  normally  stored  in  the  pelvic 
colon,  the  portion  which  lies  just  above  the  rectum. 
So  long  as  they  remain  here,  there  is  no  desire  for 
movement,  but  when  a  portion  of  fecal  matter 
has  been  pushed  down  into  the  rectum,  the  time 


120  COLON  HYGIENE 

for  evacuation  has  come,  and  the  fact  is  indicated 
by  a  more  or  less  urgent  "call."  When  the  feces 
are  fluid,  they  reach  the  lowest  part  of  the  rectum 
at  once,  and  the  "call"  is  a  very  urgent  one;  but 
if  they  are  of  normal  consistency,  they  are  at  first 
retained  in  the  upper  part  of  the  rectum,  and  the 
"call"  is  less  imperative,  and  may  be  suppressed  by 
strong  resistance. 

If,  for  any  reason,  the  bowels  are  not  permitted 
to  move  at  once,  the  "call"  usually  disappears  after 
a  few  minutes,  and  may  not  reappear  until  after 
the  next  meal  or  even  the  next  day.  In  the  mean- 
time, the  feces  which  have  entered  the  rectum  lie 
there,  and  through  the  absorption  of  water  by  the 
intestines  become  each  hour  drier  and  harder,  so  that 
when  the  "call"  comes  again  as  the  result  of  more 
feces  being  forced  into  the  rectum  and  further  dis- 
tention produced,  evacuation  may  be  difficult  or  im- 
possible without  mechanical  aid. 

It  is  possible,  also,  that  the  fecal  matters  which 
have  been  carried  down  to  the  lower  part  of  the 
colon  may  be  returned.  It  is  not  probable  that  this 
occurs  to  any  great  extent,  however,  for  new  install- 
ments of  feces  are  continually  coming  down  from  the 
upper  part  of  the  intestine,  and  hence  the  feces 
simply  accumulate,  first  in  the  pelvic  colon,  then 
in  the  iliac  and  ascending  colon,  and  finally  in  the 
transverse  colon,  and  even  in  the  cecum  and  ascend- 
ing colon. 

Although  the  bowels  may  be  permitted  to  move 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  121 

when  the  next  "call"  occurs,  the  colon  may  not  be 
fully  emptied.  The  colon  contents  may  by  this  time 
have  become  so  dry  and  hard  that  the  colon  can- 
not be  emptied  by  an  ordinary  effort.  Thus  there 
is  left  a  residue  in  the  pelvic  and  descending  colon, 
which  is  likely  to  increase  from  day  to  day,  or  at 
least  as  often  as  there  is  failure  promptly  to  answer 
the  "call"  to  evacuation. 

As  the  necessary  result  of  this  gradual  accumula- 
tion, the  pelvic  loop  of  colon  becomes  distended 
more  and  more.  This  fact  accounts  for  the  varia- 
tion in  the  size  of  this  part  of  the  colon  which  is 
far  greater  than  in  any  other  part.  The  late  Dr. 
Byron  Robinson  of  Chicago  found  in  two  hundred 
carefully  measured  pelvic  colons  a  variation  in 
length  from  five  inches  to  thirty-three  inches.  The 
writer  has  several  times  encountered  at  the  operat- 
ing table  cases  in  which  the  pelvic  colon  was  be- 
tween two  and  three  feet  in  length. 

This  stretching  may  extend  to  other  parts,  af- 
fecting chiefly,  of  course,  the  movable  parts  of  the 
colon.  The  transverse  colon  often  becomes  loaded 
with  delayed  and  dried  feces,  which  in  thin  persons 
may  be  felt  as  hard  irregular  masses  lying  in  the 
region  of  the  umbilicus. 

The  cecum  is  also  often  found  greatly  distended 
as  the  result  of  this  hoarding  of  feces  by  resisting 
the  "call".  It  is  very  probable  that  the  fecal  mat- 
ters are  sometimes  forced  back  into  the  transverse 
colon  and  the  cecum  by  the  strong  contractions  of 


122  COLON  HYGIENE 

the  colon  in  attempts  at  defecation.  When  a  "call" 
is  experienced,  there  are  at  once  set  up  colon  con- 
tractions which  would  expel  the  feces  if  permitted 
to  do  so ;  but  as  the  anus  is  held  closed  by  voluntary- 
contractions,  the  feces  cannot  be  forced  downward 
after  the  pelvic  colon  is  filled,  and  the  natural  re- 
sult is  a  slipping  back  of  fecal  matters  into  the  first 
half  of  the  colon,  some  portion  even  reaching  the 
cecum. 

By  resisting  and  ignoring  the  kindly  hint  of  Na- 
ture, that  the  body  requires  an  opportunity  to  dis- 
pose of  its  poisonous  wastes  and  refuse,  thousands^ 
perhaps  we  should  say  millions,  of  men  and  women 
have  brought  upon  themselves  untold  miseries,  and 
have  shortened  their  lives  and  have  greatly  impaired 
their  efficiency  and  usefulness.  Not  a  few  persons 
are  almost  at  once  conscious  of  injury.  A  dull 
headache  appears.  There  is  less  appetite  than 
usual  for  the  next  meal.  Sleep  is  less  sound  and  re- 
freshing. The  urine  has  a  stronger  odor,  and  the 
breath  is  offensive.  These  are  simply  the  evidences 
of  poisoning  by  absorption  of  toxins.  The  absorb- 
ent process  which  dries  out  and  hardens  the  feces, 
carries  with  the  water  that  is  taken  up  and  poured 
into  the  blood,  quantities  of  poisons  which  it  holds  in 
solution.  These  poisons  overwhelm  the  liver  with 
unnecessary  labor,  tax  the  kidneys,  irritate  or  stupe- 
fy the  brain  and  nerves,  and  disturb  every  bodily 
function. 

The  prompt  evacuation  of  the  bowels  in  response 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  123 

to  Nature's  "call"  is  a  sacred  obligation  which  no 
person  can  neglect  without  serious  injury.  Ig- 
norance of  this  fact  is  one  of  the  chief  causes  of 
the  prevalence  of  constipation,  a  condition  in  which 
the  body  becomes  a  storehouse  of  the  most  disgust- 
ing and  offensive  material,  which  saturates  the  tis- 
sues with  its  horrible  effluvium  and  its  virulent 
poisons  and  taints  the  very  springs  of  life. 

This  fault  is  perhaps  more  common  in  America 
than  in  any  other  part  of  the  world,  especially  in 
the  cities.  In  English,  German,  French  and  Aus- 
trian cities  places  are  abundantly  provided,  where 
well  kept  toilet  conveniences  are  offered  at  a  very 
small  cost.  One  sees  often  in  Vienna  such  notices 
as  the  following:  "Urinal  free.  Seats,  one  'heller' 
(a  farthing  or  half  cent)."  The  toilet  arrange- 
ments at  railway  stations  are  sanitary  and  well 
cared  for.  There  is  room  for  great  improvement 
in  this  particular  in  this  country.  Mothers  should 
give  more  attention  to  the  habits  of  their  children 
in  this  respect.  School  teachers,  at  least  in  the  pri- 
mary grades,  should  instruct  their  pupils  concern- 
ing the  importance  of  giving  prompt  heed  to  the 
"call"  of  the  bowels  for  attention.  Among  savages 
this  function  receives  much  attention.  A  missionary 
physician  tells  of  an  Arab  who  declined  to  live  in 
Aden  because  the  city  regulations  required  that  the 
bowels  should  be  evacuated  only  in  certain  places, 
as  in  all  civilized  communities,  rather  than  any- 
where at  any  time  the  "call"  demanded. 


124  COLON  HYGIENE 

The  worst  results  of  these  habits  of  postponing^ 
attention  to  the  bowels  to  a  convenient  time,  is  the 
fact  that  the  "call"  after  a  time  ceases.  It  is  no 
longer  made;  or,  if  made,  is  so  faint  that  it  is  not 
recognized.  The  continued  pressure  of  the  mass 
of  hardened  feces  upon  the  nerves  of  the  rectum 
destroys  their  sensibility,  so  that  the  "reflex"  is  no 
longer  in  operation.  The  defecatory  center  is  not 
notified  that  evacuation  is  necessary,  and  the  ac- 
cumulation of  feces  continues  with  no  remonstrance. 
Quite  a  large  proportion  of  chronic  sufferers  from 
constipation  reach  this  condition  before  they  really 
begin  to  give  serious  attention  and  study  to  the 
matter. 

There  are  thousands  of  persons  who  never  ex- 
perience a  desire  for  evacuation  of  the  bowels  ex- 
cept after  taking  a  laxative.  The  cure  of  cases  of 
this  sort  is  one  of  the  most  difficult  problems  con- 
nected with  this  class  of  disorders,  but  with  the 
thorough  co-operation  of  the  patient  the  normal 
"call"  may  be  restored  by  patient  application  of  the 
proper  measures.  No  victim  of  this  condition 
should  rest  contented  until  this  has  been  accom- 
plished. For  the  body  to  be  deaf  to  the  needs  of  its 
sewage  system,  by  which  its  most  poisonous  waste 
matters  are  removed,  is  a  far  more  dangerous  and 
serious  condition  than  for  it  to  be  deprived  of  the 
sense  of  hearing.  Fortunately  this  condition,  se- 
rious as  it  is,  may  usually  be  relieved  by  the  use  of 
simple  means. 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  125 

Hurried  Defecation 

The  act  of  defecation  normally  occupies  but  a 
few  seconds.  The  colon  acts  with  so  much  cel- 
erity that  when  watched  under  the  penetrating  X- 
rays  its  movements  can  scarcely  be  followed  by  the 
eye.  There  is  a  vigorous  surging  which  passes  in 
v/aves  from  one  end  of  the  colon  within  a  few 
seconds,  and  then  the  colon  is  at  rest;  but  it  is  easily 
seen  that  the  contents  have  either  disappeared  or 
have  been  moved  forward.  After  a  normal  move- 
ment, the  colon  is  empty  from  the  splenic  flexure 
down,  and  there  is  seen  to  have  been  a  forward 
movement  of  feces  in  other  parts  of  the  colon. 

There  are,  however,  so  many  persons  who  are 
not  quite  normal,  even_  though  apparently  healthy, 
that  perfectly  natural  bowel  movements  are  prob- 
ably the  exception  rather  than  the  rule  among  civil- 
ized adults.  It  often  happens,  at  least  after  the 
first  portion  of  feces  has  been  expelled,  that  a 
second  or  even  a  third  installment  is  brought  down, 
and  a  second  or  third  action  of  the  colon  occurs. 
The  pelvic  loop  of  the  colon  has  in  most  people 
been  so  much  abused  by  resisting  the  "call"  and  so 
compelling  an  accumulation  here,  that  it  is  often 
so  much  dilated  or  so  much  folded  upon  itself  that 
two  or  even  three  efforts  are  necessary  for  its  com- 
plete evacuation.  To  accomplish  this  requires  a 
little  patience,  and  sometimes  a  great  deal  of  per- 
severing effort.    The  first  partial  movement  empties 


126  COLON  HYGIENE 

the  rectum  and  the  lower  part  of  the  distended  pel- 
vic colon.  By  straining,  that  is,  by  strong  contrac- 
tions of  the  diaphragm,  aided  perhaps  by  pressure 
with  the  hands  upon  the  lower  abdomen  on  the  left 
side,  an  additional  portion  of  feces  may  be  forced 
down  into  the  rectum.  This  excites  the  center  of 
defecation  just  as  touching  the  back  of  the  throat 
excites  the  vomiting  center,  causes  the  colon  to  con- 
tract, the  anus  to  open,  and  reinforcement  of  the 
contraction  of  the  abdominal  muscles  with  a  second 
bowel  movement  results.  In  like  manner,  a  third 
or  even  a  fourth  movement  may  be  secured. 

But  this  requires  time,  perhaps  five,  ten  or  even 
fifteen  or  twenty  minutes.  The  bustling  or  wor- 
ried business  man,  the  hurried  clerk,  the  student 
ivho  has  barely  time  to  reach  his  school  before  roll 
call,  the  housekeeper  who  is  perhaps  superintend- 
ing some  important  culinary  operation,  these  and 
a  thousand  other  busy  individuals  believe  that  they 
have  not  time  to  devote  to  a  function  looked  upon 
as  grossly  animal  and  repulsive,  and  so  it  is  cut 
short  at  the  earliest  moment  possible. 

Ignorance  of  the  consequences  does  not,  how- 
ever, prevent  the  evil  effects  which  certainly  follow 
such  neglect.  The  feces  left  behind  in  the  half- 
emptied  pelvic  colon  become  so  dry  and  hard  be- 
fore another  opportunity  for  evacuation  occurs 
that  the  difficulty  is  greater  than  before,  and  so  a 
considerable  quantity,  often  an  increasing  amount. 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  127 

of  feces  is  held  back,  and  cumulative  constipation 
is  established. 

Undue  haste  in  bowel  movement  is  also  en- 
couraged by  unsuitable  toilet  arrangements.  In 
many  places,  especially  in  country  districts,  the  in- 
sufferable "privy"  still  exists,  and  is  a  most  prolific 
source  of  misery.  The  use  of  such  a  place  for 
evacuation  of  the  bowels  is  at  all  times  more  or 
less  inconvenient  and  offensive,  and  on  this  account 
is  avoided  as  much  as  possible,  leading  to  neglect 
of  the  "call",  and  when  necessity  compels  the  use 
of  the  offensive  place,  the  visit  is  made  as  brief  as 
possible. 

In  cold  weather,  the  danger  of  injury  from  ex- 
posure of  the  unprotected  body  to  a  low  tempera- 
ture, sometimes  even  zero  weather,  is  very  great, 
especially  in  the  case  of  feeble  or  delicate  persons. 
Extreme  cold  also  tends  to  prevent  effective  defeca- 
tion, by  contracting  the  anal  muscles  so  strongly 
as  to  negative  the  effect  of  the  automatic  reflex  by 
which  the  outlet  is  normally  opened. 

The  toilet  should  be  conveniently  placed,  and 
should  be  made  as  warm  and  comfortable  as  a 
bathroom.  It  should  be  kept  in  so  neat  and  sani- 
tary a  condition  as  to  be  in  no  way  offensive. 

The  time  devoted  to  defecation  should  be  suffi- 
cient for  complete  emptying  of  the  descending  and 
pelvic  colon.  All  fullness  and  weight  in  this  region, 
as  well  as  the  sense  of  fullness  in  the  rectum,  which 
commonly     prompts    to    bowel   movement,    should 


128  COLON  HYGIENE 

disappear  after  defecation.  If  necessary  to  occupy 
the  mind  by  glancing  over  a  morning  paper,  this 
will  do  no  harm  provided  that  it  is  not  allowed  to 
interfere  with  the  muscular  efforts  which  may  be 
necessary  to  force  down  into  the  rectum  from  the 
pelvic  colon  a  sufficient  amount  of  feces  to  induce 
an  expulsive  action  of  the  bowels. 

Unnatural  Posture  in  Defecation 

The  natural  position  in  defecation  is  squatting 
or  crouching.  All  savages  assume  this  attitude  in 
moving  the  bowels.  The  reason  for  this,  as  has 
been  fully  explained  in  a  preceding  chapter,  is  that 
in  the  natural  position  the  abdomen  is  compressed 
by  the  thighs,  and  thus  the  feces  are  forced  into  the 
rectum,  and  so  the  automatic  process  of  bowel 
movement  is  set  going. 

The  ordinary  water  closet  is  so  constructed  that 
natural  bowel  movement  is  impossible  in  its  use. 
By  bending  strongly  forward,  some  compression  of 
the  thighs  may  be  effected,  but  it  is  only  in  the 
squatting  position  that  the  pressure  can  be  as  great 
as  is  possible  and  often  necessary.  By  placing  a 
low  platform  in  front  of  the  closet  so  as  to  raise 
the  feet  eight  or  ten  inches,  this  objection  may  be 
very  largely  overcome.  Some  closets  arc  now  made 
with  this  idea  in  view,  and  are  a  great  improvement 
over  the  old  style.  The  same  thing  may  be  ac- 
complished by  the  use  of  a  chamber. 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  129 

Many  surgeons  have  learned  the  importance  of 
the  squatting  position  to  secure  complete  evacua- 
tion of  the  bowels  and  bladder,  and  forbid  the  use 
of  the  bed  pan  in  any  except  the  feeblest  cases,  re- 
quiring the  patient  to  be  supported  as  may  be  neces- 
sary while  using  the  chamber. 

Although  this  matter  is  one  of  very  great  im- 
portance, it  is  more  than  likely  that  half  a  century 
will  pass  before  manufacturers  and  plumbers,  upon 
whom  we  are  dependent  for  these  necessary  con- 
veniences, recognize  to  any  appreciable  extent  the 
need  of  a  change  in  closet  construction. 

Tlie  Use  of  Tobacco 

Numerous  laboratory  experiments  have  shown  that 
the  use  of  tobacco  in  any  form  has  a  paralyzing 
effect  upon  the  splanchnic  nerves.  Without  the  aid 
of  the  sympathetic  nerves,  normal,  rhythmical 
bowel  movements  are  impossible.  The  fact  that 
some  persons  observe  an  apparently  favorable  in- 
fluence from  smoking,  is  accepted  as  evidence  that 
the  effects  of  the  weed  are  favorable  to  the  bowels. 
These  cases  are  exceptional.  They  happen  to  be 
cases  in  which  there  is  an  excessive  action  of  the 
sympathetic  nerves,  so  that  the  paralyzing  influence 
of  tobacco  seems  to  be  helpful.  In  general,  and  in 
the  long  run,  however,  the  use  of  tobacco  is  highly 
injurious.  Kreuznach,  of  Vienna,  has  recently 
shown  that  nicotine  produces  arteriosclerosis  of  the 


130  COLON  HYGIENE 

splanchnic  vessels.  That  is,  it  produces  hardening 
and  degeneracy  of  the  vessels  which  supply  the 
colon  and  other  abdominal  organs.  This  change 
in  the  blood  vessels  gives  rise  to  general  degeneracy 
and  atony,  and  hence  to  constipation,  by  virhich  it 
is  always  accompanied. 

Alcoliol  and  Other  Narcotic  Drtigs 

Alcoholic  beverages  of  all  sorts  tend  to  produce 
constipation,  by  causing  chronic  and  intestinal  ca- 
tarrh, ulcer  of  stomach,  and  paralysis  of  the  sym- 
pathetic nerves. 

Opium  in  all  forms  produces  a  specific  effect  in 
paralyzing  the  bowels.  In  former  times  in  was 
customary  to  administer  opium  in  sufficient  doses 
in  certain  cases  to  cause  complete  inactivity  of  the 
bowels  for  a  week  or  more.  In  such  cases  the  con- 
stipation induced  was  often  the  beginning  of 
chronic  constipation  of  a  most  obstinate  character. 

The  very  common  use  of  opium  for  the  relief  of 
pain  is  a  prolific  cause  of  constipation,  especially 
among  women.  The  fact  that  a  laxative  drug  is 
given  to  overcome  the  constipating  tendency,  does 
not  prevent  the  evil  that  results,  but  only  adds 
another. 

Bromides  and  sleep-producing  or  hypnotic  drugs 
of  all  sort  tend  to  produce  constipation,  although 
some  of  them  are  less  harmful  than  opium.  For- 
tunately, the  use  of  these  drugs  may  easily  be  dis- 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION  131 

pensed  with   when   the   resources   of   hydrotherapy 
and  other  physiologic  means  are  made  use  of. 

The  Use  of  Purgatives 

One  of  the  best  evidences  of  the  universal  prev- 
alence of  constipation  is  afforded  by  the  enormous 
use  of  laxative  or  purgative  drugs.  The  quantity 
of  this  class  of  drugs  used  annually  far  exceeds 
that  of  any  other  class.  Besides  drugs  proper, 
there  is  sold  a  prodigious  quantity  of  laxative 
mineral  waters.  It  would  be  difficult  in  the  average 
community  to  find  a  household  in  which  there  is 
not  kept  on  hand  a  supply  of  some  favorite  laxa- 
tive. The  columns  of  the  newspapers  are  filled 
with  advertisements  of  drugs  which  act  upon  the 
bowels.  Many  housekeepers  lay  in  supplies  of 
bowel  medicines  as  regularly  as  the  stock  of  gro- 
ceries and  other  necessaries,  and  medical  advice  is 
sought  no  more  in  relation  to  one  than  the  other. 
Laxative  drugs  have  come  to  be  regarded  as  staple 
commodities  which  stand,  next  to  food  and  drink, 
as  necessities. 

Unquestionably,  an  inestimable  amount  of  in- 
jury is  done  by  the  use  of  these  intestinal  irritants, 
most  of  which  are  nostrums  of  the  worst  sort,  pro- 
viding temporary  relief  only  at  the  expense  of 
permanent  injury. 

It  is  not  too  much  to  say  that  all  laxative  drugs 


132  COLON  HYGIENE 

are  harmful.  There  is  no  such  thing  as  a  harm- 
less laxative  medicine. 

Laxative  drugs  act  in  different  ways,  and  some 
are  more  harmful  than  others.  "Salines"  impose 
heavy  burdens  upon  the  kidneys,  besides  irritating 
the  bowels.  When  long  used,  they  produce  an 
obstinate  intestinal  catarrh,  which  aggravates  the 
constipation.  Almost  without  exception,  laxative 
drugs  increase  the  condition  which  they  are  sup- 
posed to  cure.  The  most  difficult  cases  to  cure  are 
those  which  have  long  made  use  of  laxative  drugs. 

Not  the  least  of  the  damage  done  by  laxatives 
is  the  injury  to  the  stomach.  The  drug  is  ad- 
ministered by  the  m.outh  for  the  purpose  of  reliev- 
ing a  difficulty  at  the  other  end  of  the  digestive 
tract,  than  which  it  would  seem  nothing  could  be 
more  irrational.  In  a  large  number  of  cases  of 
constipation,  the  whole  trouble  is  a  loss  of  the  rec- 
tal reflex.  The  feces  accumulate  in  the  rectum  or 
the  pelvic  colon  because  of  failure  of  the  discharg- 
ing mechanism.  What  could  be  more  really  ab- 
surd and  irrational  than  to  irritate  and  worry  the 
stomach  and  the  whole  twenty-five  feet  of  small 
intestine,  besides  the  cecum  and  the  greater  part 
of  the  colon,  just  for  the  purpose  of  exciting  to 
action  the  last  six  inches  of  the  intestinal  tube,  the 
rectum. 

As  we  shall  see  in  the  further  study  of  this 
subject,  constipation  is  not  a  disease,  but  only  a 
symptom      The  morbid  condition  upon  which  the 


HABITS  WHICH  GIVE  RISE  TO  CONSTIPATION    1 33 

symptom  depends  may  be  any  one  of  a  score  or 
more  of  things,  or  several  in  combination.  For  the 
most  part,  these  conditions,  as  we  shall  presently 
see,  are  such  as  are  certain  to  be  greatly  aggravated 
by  the  use  of  laxatives  or  irritants  of  any  sort. 

The  use  of  laxatives  as  a  routine  measure,  a 
practice  which  is  almost  universally  in  vogue  with 
the  profession  as  well  as  with  the  laity,  is  most  illog- 
ical, and  is  productive  of  a  prodigious  amount  of 
injury. 

The  use  of  laxative  drugs  to  cure  constipation 
must  be  regarded  as  one  of  the  most  certain  and 
prolific  causes  of  this  condition,  and  a  person  who 
has  once  formed  the  habit  of  using  laxatives  must 
as  a  rule  continue  the  practice  as  long  as  he  lives, 
unless  he  is  so  fortunate  as  to  find  some  one  wise 
enough  to  show  him  the  way  out  of  his  troubles. 

The  systematic  use  of  purgatives  for  "cleansing 
the  system,"  irrespective  of  the  state  of  the  bowels, 
is  a  very  old  custom  still  in  vogue  in  various  places. 
Nothing  could  more  effectively  operate  to  produce 
the  most  obstinate  sort  of  constipation.  An  ex- 
cellent illustration  of  this  baneful  practice  and  its 
results  came  under  the  writer's  observation  a  num- 
ber of  years  ago.  A  man  past  middle  life  sought 
relief  from  a  constipation  which  he  declared  re- 
sponded to  no  drug  in  any  dose.  He  had  taken 
half  a  pound  of  "salts"  without  effect.  The  history 
which  he  gave  revealed  the  cause  of  his  unfortunate 
condition.     The  patient  stated  that  when  a  child 


134  COLON  HYGIENE 

at  home  it  was  the  practice  of  his  mother  to  give 
to  each  child  every  Friday  night  a  dose  of  "salts" 
as  a  sort  of  house-cleaning  process  to  prepare  the 
family  for  the  proper  observation  of  Sunday — 
whatever  that  may  have  meant.  The  result  was 
that  after  a  few  years  the  weekly  dose  was  quite 
insufficient,  and  daily  doses  of  increased  size  be- 
came necessary.  The  dose  increased  from  year  to 
year,  and  new  remedies  were  adopted  as  one  after 
another  ceased  to  be  effective,  until  the  whole  list 
of  laxatives  had  been  exhausted. 

In  another  case,  a  patient  who  had  taken  at  first 
small  doses  of  licorice  root  and  other  simples,  had 
become  so  constipated  that  even  croton  oil  no  longer 
produced  laxative  effects.  The  only  remedy  that 
remained  at  all  efficient  was  a  tablespoonful  of  un- 
ground  mustard  seed  taken  before  breakfast.  Many 
more  lamentable  examples  of  addiction  to  harm- 
ful and  disease-producing  laxatives  might  be  cited, 
but  such  cases  are  familiar  to  every  trained  nurse  as 
well  as  all  physicians. 


Disorders   of  the   Digestive  Tube 
Associated   with   and   Caus- 
ing  Constipation 

The  disorders  of  the  alimentary  canal,  which 
give  rise  to  constipation,  are  very  numerous.  Some 
are  purely  functional  in  character,  others  are  or- 
ganic or  structural  affections.  All  are  of  a  nature 
which  cannot  possibly  be  relieved  by  laxative  drugs, 
at  least,  more  than  temporarily,  and  most  are  likely 
to  be  made  worse  by  their  use,  a  fact  which  shows 
the  folly  of  depending  upon  them  for  the  relief 
of  this  condition,  which  unfortunately  is  rarely 
treated  in  any  other  way. 

First  let  us  study  some  of  the  functional  dis- 
turbances of  the  digestive  tract,  which  may  give 
rise  to  inaction  of  the  bowels. 

Lack  of  Appetite. — Lack  of  desire  for  food  is  a 
common  result  of  constipation,  and  may  also  be  a 
cause  of  this  condition,  when  it  is  the  result  of 
some  other  cause,  as  lack  of  exercise,  excessive 
heat,  etc.  With  loss  of  appetite  there  is  absence 
of  relish  for  food,  and  hence  a  failure  of  the  meal 
to  awaken  those  lively  peristaltic  movements  which 
are  essential  to  propel  forward  in  the  colon  the 
hardening  masses  of  fecal  matter  which  are  stored 
up  in  its  lower  segments  waiting  to  be  discharged. 
Those  who  eat  without  appetite  are  always  consti- 

135 


136  COLON  HYGIENE 

pated,  and  while  the  lack  of  relish  for  the  food 
encourages  the  constipation,  the  latter  still  further 
lessens  the  appetite,  and  so  the  difficulty  continual- 
ly becomes  more  and  more  aggravated. 

In  this  condition  there  is  usually  found  a  coated 
tongue  and  foul  breath,  which  point  unmistakably 
to  a  state  of  low  vital  resistance  and  malnutrition. 
With  the  removal  of  these  conditions  by  the  appli- 
cation of  the  proper  measures,  the  appetite  will 
improve  and  the  bowels,  if  not  organically  crip- 
pled, will  assume  their  normal  rhythm. 

Atony  or  weakness  of  the  muscular  walls  of  the 
colon  itself,  is  no  doubt  sometimes  a  cause  of  very 
obstinate  constipation.  This  condition  sometimes 
appears  to  be  hereditary.  It  occurs  in  families  as 
a  family  characteristic.  It  is  possible  that  in  these 
cases  the  condition  is  only  the  result  of  improper 
care  in  infancy.  No  doubt  a  great  number  of 
cases  of  chronic  dyspepsia  and  chronic  constipation 
have  their  origin  in  the  very  earliest  period  of  in- 
fancy. Prolonged  indigestion  in  an  infant  may  so 
damage  its  stomach  and  colon  as  to  cripple  these 
organs  for  life.  The  delicate  structures  of  an  in- 
fant's colon  are  easily  stretched  to  such  a  degree 
as  to  be  damaged  permanently  and  to  become  a 
source  of  trouble  during  the  whole  after  life. 
Cases  of  constipation  which  have  existed  for  a  life 
time  are  not  infrequentl}''  encountered.  Fortunately 
even  these  cases  are  often  curable  by  the  use  of 
rational  means. 


DISORDERS  OF  THE  DIGESTIVE  TUBE    137 

Atony  of  the  colon  is  especially  likely  to  be 
encountered  in  persons  long  past  middle  age;  but 
it  is  not  at  all  rare  to  meet  cases,  especially  v/o- 
men,  in  which  the  colon  shows  all  the  signs  of 
senility  at  forty  years,  or  even  earlier.  The  age 
of  the  colon,  like  that  of  the  arteries,  is  not  to  be 
reckoned  in  years,  but  is  to  be  judged  by  the  ex- 
isting degree  of  tissue  change.  A  colon  which 
has  been  continually  distended  with  putrefying 
feces  or  poisonous  gases  during  twenty  years  or  so 
is  a  senile  colon,  no  matter  what  the  reputed  age 
of  the  possessor.  An  eminent  French  physiologist 
has  said,  "A  man  is  as  old  as  his  arteries;"  and 
it  might  be  said  with  almost  equal  truth,  "A  man 
is  as  old  as  his  colon." 

In  fever  the  colon  as  well  as  other  parts  of  the 
intestine  is  in  a  state  of  semi-paralysis.  The  ele- 
vated temperature  of  the  blood  paralyzes  the  sym- 
pathetic nerves,  and  so  interferes  with  rhythmical 
movements  and  causes  constipation.  Very  hot 
weather  and  exposure  to  high  artificial  tempera- 
tures produce  a  like  effect. 

In  cases  of  extreme  obesity,  in  which  there  are 
abnormal  fat  accumulations  and  fatty  changes  in 
various  parts  of  the  body,  the  intestine  suffers  with 
other  tissues,  even  undergoing  fatty  changes  which 
render  it  less  effective  in  transporting  its  contents 
and  resulting  in  stasis  and  constipation. 

Painful  Affections  of  the  Abdomen. — Pain  in 
almost  any  part  of  the  abdomen  may  cause  consti- 


138  COLON  HYGIENE 

pation,  through  reflex  arrest  of  peristaltic  move- 
ment, and  spasm  of  the  ileocecal  or  pelvi-rectal 
valve.  Chronic  appendicitis  is  a  common  cause  of 
this  form  of  colon  inactivity,  sometimes  called 
reflex  constipation.  The  discovery  of  the  fact  that 
there  is  a  sphincter  at  the  ileocecal  valve  explains 
the  relief  from  constipation,  which  often  follows 
an  operation  for  appendicitis.  Painful  affections 
of  the  uterus,  ovaries  and  uterine  appendages,  in- 
flammation of  the  prostate  gland,  painful  hemor- 
rhoids, rectal  ulcer,  and  possibly  ulcer  of  the 
stomach  and  duodenum  may,  through  reflex  dis- 
turbance of  the  sympathetic  centers  cause  spasm  of 
the  ileocecal  sphincter,  and  obstinate  constipation. 
The  most  common  cause  of  spasm  of  the  ileocecal 
valve,  however,  is  inflammation  of  the  appendix,  an 
affection  which  is  even  more  common  than  is  gener- 
ally supposed.  The  infection  of  the  colon  commonly 
known  as  colitis  readily  extends  into  the  appendix, 
which  often  becomes  adherent  to  the  lower  end  of  the 
small  intestine  and  interferes  with  the  action  of  the 
ileocecal  valve,  both  by  causing  spasm  of  the  ileo- 
cecal sphincter  and  by  preventing  proper  closure  of 
the  lips  of  the  valve,  so  as  to  prevent  the  reflux  of 
fecal  matters  from  the  colon.  Interference  with 
the  closure  of  the  valve  is  also  prevented  by  ad- 
hesions of  the  appendix  to  the  cecum,  a  very  common 
condition.  Delay  of  the  intestinal  contents  in  the 
lower  part  of  the  small  intestine,  either  by  spasm  of 
the  valve  or  incompetency  (failure  to  close),  is  one 


A    Spastic  Colon.    Darkest    Portion    Shows    Dila- 
tation— Arrows  Indicate  Spastic   Condition 


DISORDERS  OF  THE  DIGESTIVE  TUBE     139 

of  the  most  pernicious  forms  of  constipation.  The 
delay  occurs  at  a  point  where  putrefaction  is  most 
active  and  absorption  is  also  greatest.  Cases  of  this 
sort  usually  present  very  active  symptoms  of  in- 
testinal toxemia.  Such  persons  are  often  victims 
of  attacks  of  violent  headache.  They  show  much 
indican  in  the  urine,  are  likely  to  have  high  blood- 
pressure,  and  sooner  or  later  develop  chronic  Bright's 
disease  of  the  kidnej's. 

Painful  affections  of  the  abdominal  organs,  such 
as  chronic  appendicitis,  colitis,  adhesions  following 
an  abdominal  operation,  pelvic  or  bladder  disease, 
may  cause  constipation,  not  only  hy  producing  reflex 
spasm  of  the  ileocecal  valve,  but  by  restraining  the 
patient  from  making  the  necessary  effort  to  expel 
the  colon  contents.  Such  efforts  naturally  increase 
the  pain,  and  so  are  dreaded  and  avoided.  In  such 
cases  the  application  of  a  hot  fomentation  over  the 
seat  of  pain  before  ordering  the  effort  to  move  the 
bowels  will  often  render  very  great  service.  A 
hot  sitz  bath  may  be  taken  instead.  A  hot  water  bag 
placed  against  the  abdomen  may  be  found  useful 
both  by  lessening  pain  and  as  a  mechanical  aid  to 
defecation. 

Depressing  Emotions.  —  Fear,  disappointment, 
anger,  or  any  depressing  emotion,  may,  through 
the  sympathetic  nerves,  cause  reflex  constipation. 
Prof,  Anderson,  an  eminent  Danish  physiologist 
who  has  made  an  exhaustive  study  of  the  influence 
of    the    emotions,    found    that     depressing    emo- 


140  COLON  HYGIENE 

tions  powerfully  excite  the  sympathetic.  Some 
persons  are  unable  to  move  their  bowels  be- 
cause they  are  in  a  state  of  fear  that  they  cannot. 
All  persons  are  more  or  less  at  the  mercy  of  the 
sympathetic  nervous  S5^stem,  but  some  much  more 
than  others.  A  curious  example  of  the  effect  of 
mental  influence  is  the  case  of  a  woman  mentioned 
by  Hertz  whose  bowels  were  obstinately  constipated 
but  who  had  a  good  movement  of  the  bowels 
whenever  she  gave  one  of  her  children  a  dose  of 
castor  oil,  although  the  oil  produced  no  effect  when 
she  took  it  herself. 

Obstructions. — Probably  half  the  cases  of 
chronic  constipation  are  really  due  to  some  form 
of  obstruction  at  some  point  along  the  food  canal. 
It  miatters  little,  apparently,  where  the  obstruction 
is;  the  effect  is  delay,  and  this  results  in  constipa- 
tion from  absorption  of  water  and  the  resulting  ex- 
cessive dryness  of  the  feces. 

Contracted  Colon. — In  cases  of  reflex  spasm  of 
the  colon,  or  spasm  due  to  colitis,  the  intestine  can 
often  be  felt  under  the  fingers,  to  which  it  gives 
the  sensation  of  a  rubber  tube.  When  the  contrac- 
tion is  due  to  colitis,  the  intestine  is  not  only  hard 
and  contracted  but  is  also  tender  to  pressure,  some- 
times extremely  so.  In  such  cases  there  are  likely 
to  be  present  various  reflex  pains  such  as  headache, 
or  pains  in  the  legs,  which  in  women  suggest 
ovarian  inflammation  or  some  other  pelvic  disease. 

This  condition  of  the  colon  is  most  often  found 


DISORDERS  OF  THE  DIGESTIVE  TUBE     141 

on  the  left  side,  at  the  site  of  the  iliac  colon,  some- 
times extending  upward,  and  may  occasionally  be 
felt  in  the  pelvic  colon  also.  The  cecum  and  the 
ascending  colon  are  not  infrequently  affected,  and 
more  rarely  the  transverse  colon,  which  may  be 
felt  as  a  hard  round  cord  passing  across  the  abdo- 
men just  above  or  below  the  umbilicus. 

These  spastic  contractions  are  not  permanent; 
they  come  and  go,  sometimes  disappearing  while 
under  the  examining  linger;  but  they  cause  great 
delay  in  the  progress  of  the  feces  along  the  bowel, 
and  thus  lead  to  excessive  dryness  and  constipation. 

Organic  or  permanent  contraction  of  the  colon 
is  a  much  more  serious  condition  than  simple  spas- 
tic contraction,  because  usually  incurable,  except  by 
surgery.  It  may  be  the  result  of  peritonitis  or  of 
colitis  foUov/ed  by  pericolitis  and  adhesions. 

Incompetency  of  the  Ileocecal  Valve 

One  of  the  consequences  of  chronic  constipation 
is  incompetency  of  the  ileocecal  valve.  By  over- 
distention  the  intestine  becomes  so  widely  dilated 
that  the  lips  of  the  valve  no  longer  come  in  contact 
and  so  its  check  valve  action  is  prevented,  and  the 
putrefying  contents  of  the  colon  readily  pass  back- 
ward into  the  small  intestine.  The  infection  thus 
induced  may  travel  backward  the  entire  length  of 
the  small  intestine,  to  the  stomach,  liver,  gall-blad- 
der, pancreas  and  duodenum,  giving  rise  to  ulcer 


142  COLON  HYGIENE 

of  the  stomach,  duodenal  ulcer,  gall-stones,  inflam- 
mation of  the  gall-bladder,  infections  of  the  liver 
and  jaundice  resulting  from  these  conditions,  and 
pancreatitis,  a  still  more  serious  condition.  It  is 
probable  also  that  the  worst  effects  attributed  to 
alimentary  toxemia  or  intestinal  intoxication  are 
seen  in  cases  in  which  through  incompetency  of  the 
ileocecal  valve,  the  putrefying  materials  of  the 
colon  find  ready  entrance  to  the  small  intestine, 
and  are  thus  rapidly  absorbed. 

When  the  ileocecal  valve  is  incompetent,  it  is 
of  course  incompetent  to  gases  as  well  as  liquids. 
There  is  evidence  that  the  valve  sometimes  becomes 
incompetent  to  gases  while  it  still  may  be  com- 
petent to  liquids.  Patients  whose  ileocecal  valves 
are  incompetent  suffer  from  great  discomfort  be- 
cause of  inability  to  expel  gas  from  the  intestine. 
When  an  expulsive  effort  is  made  gas  passes  in  both 
directions,  that  is,  out  of  the  body  and  back  up  into 
the  small  intestine. 

There  is  reason  to  believe  that  the  failure  of 
short-circuiting  operations  either  with  or  without 
removal  of  the  colon  or  a  part  of  it,  is  often  due  to 
loss  of  the  function  of  the  ileocecal  valve,  which  is 
of  course  removed  with  the  colon.  Recent  ad- 
vances in  the  department  of  surgery  make  it  pos- 
sible to  remedy  this  defect  by  constructing  an  ar- 
tificial   ileocecal   valve. 

In  like  manner  incompetency  of  the  ileocecal 
check  valve  interferes  with  the  complete  and  proper 


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DISORDERS  OF  THE  DIGESTIVE  TUBE     143 

emptying  of  the  colon  and  thus  becomes  a  cause  as 
well  as  a  consequence  of  constipation. 

The  worst  evils  resulting  from  incompetency 
of  the  ileocecal  valve  may  be  corrected  in  the  ma- 
jority of  cases  by  removing  the  cause,  namely,  re- 
lieving the  constipation  to  which  it  is  due.  While 
in  a  majority  of  cases,  this  may  be  accomplished  by 
the  employment  of  the  thoroughgoing  measures 
suggested  in  this  volume,  a  few  cases  remain  in 
which  an  operation  is  required  for  breaking  up 
adhesions  of  the  pelvic  colon  and  removing  the 
other  obstructions  which  have  been  the  cause  of 
the  overloading  and  the  distention  of  the  cecum, 
which  produced  the  incompetency  of  the  valve. 
Fortunately  such  cases  may  be  relieved  by  surgical 
operation,  and  it  is  even  possible  to  repair  the  valve 
so  as  to  enable  it  to  resume  its  function. 

"Greedy  Colon" 

Goodhard,  Schmidt,  and  others  hold  that  abnor- 
mal dryness  of  the  feces  may  be  produced  by  excess- 
ive digestion  and  absorption,  leaving  so  little  residue 
that  the  bulk  of  the  intestinal  contents  is  too  small 
to  stimulate  peristaltic  action.  It  is  possible  that 
cases  of  this  sort  may  exist,  but  it  seems  more  prob- 
able that  the  fault  is  a  too  concentrated  diet  or 
deficient  gastric  or  intestinal  secretion,  at  least  in 
most  of  the  cases  in  which  this  diagnosis  has  been 
made.    It  is  much  easier  *;o  see  how  the  intestine  can 


144  COLON  HYGIENE 

fail  to  do  its  work  completely  than  to  understand 
a  condition  of  excessive  activity  of  digestion. 

Excessive  Dryness  of  the  Feces 

Persons  vi^ho  sweat  profusely,  even  if  their 
habits  are  active,  often  suffer  from  constipation, 
because  of  dryness  of  the  stool.  This  condition  may 
also  result  from  sweating  baths  and  from  the 
drinking  of  an  insufficient  amount  of  fluid,  as  we 
have    already   seen. 

Excessive  activity  of  the  kidneys,  as  in  diabetes 
mellitus  or  diabetes  insipidus^  may  prodaice  the  same 
result,  by  depriving  the  feces  of  water. 

A  deficiency  of  fat  in  the  food  leads  to  constipa- 
tion in  like  manner.  The  presence  in  the  feces  of 
a  certain  amount  of  unabsorbed  fat  is  useful  not 
only  to  prevent  excessive  dryness,  but  to  prevent 
too  great  adhesiveness  of  the  feces  and  thus  to  fa- 
cilitate movement  along  the  colon. 

Contraction  of  the  Ileocecal  Valve 

Various  causes,  as  we  have  already  seen,  may 
cause  delay  at  the  ileocecal  valve,  such  as  reflex 
spasm  set  up  by  pain  in  neighboring  organs,  and  the 
irritation  of  condiments  or  imperfectly  digested 
foodstuffs.  Colitis  may  cause  thickening  of  the 
valve  and  partial  obstruction.  Recent  observations 
have  shown  that  the  valve  is  sometimes  too  small 
at    birth,    causing    congenital    constipation.      This 


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Marked  ileac  stasis.  Roentgenogram  made  nine  and  a  half 
hours  after  barium  meal.  Arrows  a,  b  and  c  point  to  several 
coils  of  the  terminal  ileum  still  filled  at  this  hour.  The  re- 
mainder of  the  barium  is  in  the  colon,  where  it  all  should 
have   been   before   the  ninth  hour.      (Case.) 


DISORDERS  OF  THE  DIGESTIVE  TUBE     145 

form  of  incompetenq/^  of  the  valve  is  fortunately 
very  rare,  and  like  others  may  be  remedied. 

Incompetency  is  both  a  consequence  and  a  cause 
of  constipation.  The  valve  is  often  rendered  in- 
competent by  over-stretching  of  the  bowel,  usually 
the  result  of  obstruction  in  the  descending  or 
pelvic  colon.  When  once  the  valve  is  crippled,  the 
constipation  is  made  worse  by  the  loss  of  the  check- 
valve  action  which  aids  the  forward  movement  of 
the  bovi^el  contents,  so  that  the  food  residues  oscil- 
late back  and  forth  between  the  large  and  the 
small  bowel,  until  the  water  content  is  so  much  re- 
duced that  a  pasty  mass  is  formed,  which  is  pushed 
forward  only  with  great  difficulty  by  the  bowel, 
which  at  this  point  is  adapted  to  dealing  with  thin 
liquids   rather   than   semi-solid    adhesive   materials. 

The  stagnation  resulting  from  this  condition 
readily  leads  to  infection  of  the  cecum  and  appendi- 
citis, and  to  more  remote  affections,  through  ex- 
tension of  the  infection  backward  along  the  small 
intestine  to  the  duodenum,  stomach,  gall-bladder, 
liver  and  pancreas,  causing  inflammation  of  the  gall 
ducts  and  gall-bladder,  gall-stones,  pancreatitis  and 
possibly  diabetes,  duodenal  and  gastric  ulcers,  and 
various  other  allied  affections. 

Delay  at  the  Hepatic  Flexure 

The  cecum  is  a  rather  thin  walled  pouch,  in- 
tended only  for  holding  a  small  amount  of  liquid 
for  a  comparatively  short  time.     When  the  bowels 


146  COLON  HYGIENE 

are  restrained  from  normal  action,  by  resisting  the 
"call"  for  evacuation,  the  cecum  becomes  filled  by 
the  backing  up  of  semi-solid  feces,  which  cause  it 
to  sag  down,  and  in  time  dilate  and  displace  it. 
The  over-filled  and  heavy  cecum  drags  heavily 
upon  the  hepatic  flexure,  and  so  narrows  the  pas- 
sage along  the  colon  at  this  point  as  to  produce 
partial  obstruction  and  delay  in  the  movement  of 
feces  from  the  cecum  over  into  the  transverse 
colon.  The  observations  of  Virchow,  Lane  and 
others  have  shown  that  adhesions  are  often  found 
at  this  point,  which  narrow  the  bowel  and  pro- 
duce more  or  less  obstruction  and  delay. 

Delay  at  the  Splenic  Flexure 

At  the  splenic  flexure  the  bowel  forms  a  very 
acute  angle,  so  that  the  colon  is  narrower  at  this 
point  than  at  any  other.  The  overloading  of  the 
transverse  colon,  which  results  from  gross  neglect 
to  attend  promptly  to  the  "call"  of  Nature,  drags 
heavily  upon  the  splenic  flexure,  and  causes  such 
narrowing  of  the  bowel  as  to  result  in  very  con- 
siderable  obstruction   and   delay. 

As  the  feces  are  banked  up  in  the  transverse 
colon,  this  segment  of  the  intestines  sags  more  and 
more  until  it  may  be  stretched  to  the  very  bottom 
of  the  pelvis.  This  process  of  prolapse  is,  of  course, 
greatly  favored  by  weakness  of  the  abdominal 
muscles. 


DISORDERS  OF  THE  DIGESTIVE  TUBE     147 
Delay  at  the  Pelvi-rectal  Junction 

The  passage  from  the  colon  to  the  rec- 
tum, which  is  closed  and  opened  by  the  falling 
and  rising  of  the  pelvic  loop  of  the  colon, 
is  sometimes  obstructed  by  thickening  due  to  in- 
flammation or  ulceration.  Sometimes  the  pelvic 
colon  becomes  adherent  to  the  pelvic  floor  so  that 
it  cannot  rise,  and  there  is  more  or  less  obstruction 
to  the  passage  of  feces  into  the  rectum.  In  such  a 
case,  there  must  of  necessity  be  an  accumulation  of 
feces  in  the  lower  bowel  above  the  rectum,  and 
as  a  consequence  cumulative  constipation  will  be 
found  present. 

The  inflammatory  process  by  which  adhesions 
and  thickenings  are  produced  is  easily  set  up  by  the 
colitis  and  other  infections  which  are  the  natural 
consequence  of  retention  of  feces  in  the  bowel  for 
an  undue  length  of  time,  such  as  results  from 
postponing  the  evacuation  of  the  bowels,  or  from 
excessive  dryness  of  the  stool  from  any  cause. 
Stasis,  that  is,  delay  of  fecal  matters  at  any  point 
in  their  journey  through  the  colon,  is  likely  to  be 
followed  by  inflammation  not  only  within  the 
bowel  but  in  the  whole  thickness  of  the  bowel  wall 
and  on  its  outer  surface,  thus  leading  to  adhesions 
and  loss  of  contractile  power.  An  inflamed  and 
thickened  bowel  is  always  crippled  and  incapable 
of  contracting  upon  the  bowel  contents  in  a  normal 
way. 


148  COLON  HYGIENE 

Thickenmg  of  Houston's  Valves 

It  IS  believed  by  some  surgeons  that  these  mem- 
branous valves  sometimes  become  so  thickened  as 
to  form  an  obstruction  to  the  passage  of  feces.  The 
writer  has  seen  no  cases  of  this  sort,  although  he 
has  carefully  looked  for  them  in  hundreds  of 
cases. 

Delay  at  the  Outlet 

Failure  of  the  anus  to  relax  when  the  colon  con- 
tracts interferes  seriously  with  defecation,  and  may 
prevent  movement  of  the  bowels.  This  may  re- 
sult from  various  causes,  as  a  weak  stimulus  from 
the  defecation  center,  or  unduly  contracted  anal 
muscles.  This  point  will  be  considered  further  in 
another  connection. 

Kinks 

Virchow  was  the  first  to  observe  the  conditions 
to  which  Mr.  Lane,  an  eminent  London  surgeon, 
first  applied  the  term  "kinks,"  but  his  observations 
received  little  attention  until  within  recent  years. 
Mr.  Lane  has  shown  the  important  relation  which 
they  bear  to  the  functions  of  the  colon  and  to 
general  conditions  of  the  body  arising  from  auto- 
intoxication. 

The  narrowing  which  occurs  from  folding  of 
the  bowfel  or  compression  by  bands,  is  usually  the 
result  of   adhesions.        The   obstruction   thus   pro- 


DISORDERS  OF  THE  DIGESTIVE  TUBE     149 

duced  causes  stasis,  or  stagnation,  and  increase  of 
putrefactive  changes  in  the  foodstuffs,  with  infec- 
tions of  the  intestine,  from  which  come  still  further 
thickening  and  narrowing  of  the  bowel,  and  so 
continual  increase  of  delay  and  of  constipation. 

The  pelvic  loop  sometimes  becomes  so  much 
elongated  that  when  it  is  emptied  and  falls  over 
backward  into  the  pelvis  it  makes  several  folds 
upon  itself.  If  adhesions  form  an  extension  of  infec- 
tion through  the  wall  to  the  outer  surface,  as  they 
sometimes  do  from  pericolitis,  "kinks"  are  developed 
which  may  require  surgical  means  of  relief. 

"Lane's  Kink" 

Within  the  last  dozen  years  there  has  been  much 
discussion  in  medical  circles  about  a  "kink"  located 
at  the  lower  end  of  the  small  intestine  within  a 
few  inches  of  the  ileocecal  valve.  Lane,  of  Lon- 
don, has  attributed  to  these  adhesions  of  the  terminal 
ileum  stasis  or  stagnation  of  materials  in  the  ileum, 
and  most  of  the  disease  conditions  which  develop  in 
the  stomach,  liver,  duodenum,  gall-bladder  and  pan- 
creas. 

Recent  observations  made  at  the  operating  table 
by  the  writer  and  others,  clearly  show,  however,  that 
"Lane's  Kink"  is  practically  always  associated  with 
incompetency  of  the  ileocecal  valve.  It  seems  most 
probable  that  adhesions  of  the  lower  end  of  the 
ileum  are  the  result  of  inflammation  caused  by  the 


^50  COLON  HYGIENE 

backing  up  of  fecal  matters  into  the  small  intestine 
through  the  open  valve.  It  has  also  been  observed 
that  these  "ileal  kinks,"  first  mentioned  by  Lane, 
are  seldom  obstructive,  the  real  cause  of  the  delay  in 
the  small  intestine  associated  with  "kinks"  being 
incompetency  of  the  ileocecal  valve,  which  also  is 
the  cause  of  the  "kink." 

Mechanical  Effects  of  Constipation 

Fecal  accumulations  in  the  rectum,  and  in  some 
cases  possibly  also  accumulations  in  the  pelvic  colon 
and  in  the  caecum,  may  give  rise  to  various  reflex 
pains  on  account  of  pressure.  Pain  in  the  buttocks 
and  the  back  of  the  thigh,  and  a  dull  pain  in  the 
region  of  the  sacrum  is  often  due  to  the  pressure  of 
fecal  matters  in  the  rectum.  Neuralgia  of  the 
testicles  and  of  the  ovaries,  and  dysmenorrhea  in 
young  women,  is  often  traceable  to  this  cause.  Ab- 
normal sexual  excitability,  especially  during  sleep, 
is  also  sometimes  traceable  to  accumulations  in  the 
rectum.  Itching  about  the  anus,  is  often  caused 
by  the  pressure  of  a  small  amount  of  fecal  matter 
in  the  anal  canal,  disappearing  at  once  when  the 
feces  are  removed.  Hemorrhoids  may  be  caused  by 
the  pressure  of  fecal  matters  upon  the  hemorrhoidal 
veins;  and  varicocele,  if  not  produced,  is  certainly 
aggravated  by  accumulations  of  fecal  matters  in  the 
iliac  colon. 

Headache  and  sometimes  vertigo  and  a  sensation 


DISORDERS  OF  THE  DIGESTIVE  TUBE     151 

of  exhaustion  and  depression  are  symptoms  com- 
monly experienced  by  persons  suffering  from  cumu- 
lative constipation.  These  symptoms  may  be  the 
result  of  reflex  action,  which  seems  most  probable^ 
or  they  may  be  in  whole  or  in  part  the  result  of 
chronic  poisoning  due  to  the  absorption  of  long 
retained  fecal  matters.  The  fact  that  the  symptoms 
disappear  almost  immediately  when  the  bowel  is 
emptied  by  an  enema,  does  not  necessarily  indicate 
that  the  act  is  reflex.  Effects  due  to  autointoxication 
are  the  result  of  over-saturation  of  the  blood  with 
poisons  derived  from  the  bowel  contents.  When, 
by  removal  of  the  source  of  the  poisons,  the  intake 
ceases,  the  liver  and  kidneys  quickly  clear  the  blood 
of  the  subtle  intoxicants,  and  the  nerve  disturbance 
ceases. 

The  Bad  Effects  of  Straining 

The  violent  straining  occasioned  by  the  presence 
of  dry  and  hard  feces  in  the  rectum  and  lower  colon 
is  not  merely  an  inconvenience,  but  often  results  in 
serious  and  sometimes  fatal  injury. 

One  of  the  most  common  results  of  straining  at 
stool,  especially  when  prolonged  or  repeated  several 
times  daily,  is  hemorrhoids,  or  piles.  These  are 
excrescences  which  form  just  in  the  anus,  or  at  its 
lower  edge.  The  accumulation  of  fecal  matters  in 
the  rectum  obstructs  the  flow  of  blood  in  the  veins 
which  have  their  origin  at  this  point,  and  in  straining 
these  veins  become  greatly  distended  with  blood; 


152  COLON  HYGIENE 

their  walls  become  thickened,  forming  irregular 
masses  which  are  usually  forced  out  when  the  bowels 
move.  As  the  result  of  the  straining,  and  often 
as  the  result  of  the  use  of  rough  toilet  paper,  the  deli- 
cate mucous  membrane  becomes  abraded  or  cracked, 
infection  occurs,  and  the  hemorrhoids  become  in- 
flamed and  swollen  causing  still  further  thickening. 
Thus  the  hemorrhoids  gradually  increase  in  size,  un- 
til they  may  become  so  large  that  the  anal  sphincters 
are  over-stretched  and  become  relaxed,  and  in  time 
the  rectum  may  be  pushed  outside  whenever  the 
bowels  move.  Prolapse  of  the  rectum  is  most  likely 
to  occur  in  children  and  emaciated  adults. 

In  persons  suffering  from  arteriosclerosis  or  de- 
generation of  the  blood-vessels,  especially  aged  per- 
sons, straining  at  stool  may  cause  rupture  of  a  blood 
vessel  and  sudden  death.  In  angina  pectoris  a 
spasm  may  result  from  straining  at  stool,  sudden 
death  having  been  known  to  occur  in  cases  in  which 
the  heart  was  very  feeble. 

Stricture 

The  bowel  may  be  narrowed  by  the  contraction 
of  the  scar  left  behind  by  a  healed  ulcer  due  to  tuber- 
culosis, t5^phoid  fever  or  other  cause.  When  such 
strictures  are  present,  the  peristaltic  movements  of 
the  intestine  are  often  so  strong  as  to  be  visible  in 
a  thin  patient  through  the  abdominal  walls.  Such 
cases  require  operation. 


DISORDERS  OF  THE  DIGESTIVE  TUBE     153 

Cancers  and  Tumors 

Cancer  of  the  colon  is  not  infrequent,  constitut- 
ing about  nine  per  cent  of  all  cancers.  Cancer 
occurs  most  frequently  in  the  cecum  or  ascending 
colon,  and  next  most  frequently  in  the  rectum  or 
pelvic  colon,  points  at  which  the  greatest  de- 
lay of  the  feces  occurs. 

Cancer  of  the  colon  is  not  infrequently  secondary 
to  cancer  in  some  other  location.  When  cancer 
exists  or  has  existed  in  the  breast,  stomach,  or  else- 
where, obstinate  constipation  should  lead  to  a  care- 
ful physical  examination  including  an  X-ray  ex- 
amination of  the  colon  with  special  reference  to 
the  presence  of  organic  obstruction. 

Intussusception 

Acute  obstruction  due  to  "telescoping"  of  the 
intestine    requires   immediate   surgical    attention. 

Chronic  constipation  is  held  to  be  sometimes 
due  to  such  a  telescoping  of  the  pelvic  colon  into 
the  rectum.  This  condition  is  probably  quite 
rare,  but  it  possibly  may  be  more  frequent  than 
has  been  hitherto  supposed.  Such  cases  require 
surgical  attention. 

Disturbance  of  tlie  Discharging  Mechanism 

The  feces  are  formed  by  the  gradual  absorption 
of  the  digested  foodstuffs,   and  the  drying  out  of 


154  COLON  HYGIENE 

the  mass  of  debris  left  through  the  absorption  of 
water.  When  thus  formed,  the  feces  are  slowly 
moved  along  the  colon  toward  the  lowermost  part 
of  the  colon  proper,  the  pelvic  colon,  where  they 
are  deposited,  the  pelvic  loop  filling  from  below 
upward.  The  filling  begins  at  the  bottom  of  the 
loop,  the  junction  of  the  colon  with  the  rectum. 

At  this  point  a  new  mechanism  is  provided  to 
deal  with  the  feces.  They  have  become  so  dried 
and  hardened  by  the  absorption  of  their  liquid 
part  that  they  are  no  longer  suited  for  transpor- 
tation by  the  feeble  peristaltic  waves  which  con- 
tinually course  from  one  end  of  the  intestinal  tract 
to  the  other.  They  must  be  dealt  with  by  a  more 
powerful  mechanism.  This  may  be  termed  the 
discharging  mechanism  or  device,  and  it  is  certainly 
a  most  remarkable  apparatus.  We  need  not  repeat 
here  the  description  of  the  process  of  defecation, 
which  has  been  given  in  detail  elsewhere.  Briefly 
summarized,  it  consists  of  three  voluntary  and  four 
involuntary  acts. 

1.  Voluntary  acts  in  defecation:  (a)  Con- 
traction of  the  diaphragm,  (b)  Contraction  of  the 
abdominal  muscles,  (c)  Compression  of  the  abdo- 
men by  the  thighs. 

2.  I  voluntary  acts  in  defecation:  (a)  Con- 
traction of  the  colon,  (b)  Relaxation  of  opening  of 
the  anus,  (c)  Reinforced  contraction  of  the  ab- 
dominal muscles,  (d)  Strong  contraction  of  the 
levator  ani  muscles   lying  behind   the   rectum. 


DISORDERS  OF  THE  DIGESTIVE  TUBE    155 

When  each  of  these  several  distinct  voluntary 
and  involuntary  acts  is  promptly  and  efficiently 
performed,  defecation  is  complete,  and  at  least  the 
lower  half  of  the  colon  is  completely  emptied. 
Failure  at  any  point  results  in  incomplete  defeca- 
tion, and  fecal  matters  are  left  behind,  producing 
cumulative  constipation.  Let  us  note  the  different 
ways  in  which  these  several  acts  may  be  interfered 
with. 

Weak  Contraction  of  the  DiapIiragKi 

If  the  diaphragm  is  weak  from  disuse  or  general 
feebleness,  if  its  movements  are  obstructed  by  cor- 
sets or  waist  bands,  if  it  is  tied  fast  by  adhesions 
from  pleurisy  or  crippled  by  hernia,  it  cannot  act 
efficiently,  and  the  amount  of  feces  pushed  down 
into  the  rectum  may  not  be  sufficient  to  call  forth 
a  vigorous  act  of  defecation.  The  result  will  be 
that  the  colon  will  be  only  partially  emptied,  and 
cumulative  constipation  will  result,  though  the 
rectum  may  be  fully  emptied  and  no  sense  of  dis- 
comfort be  felt.  The  pelvic  colon  will  be  grad- 
ually stretched  by  the  accumulating  contents  until 
it  becomes  enormously  enlarged  and  forms  a  reser- 
voir of  putrefying  feces,  by  which  the  body  is  con- 
tinually poisoned,  and  a  great  variety  of  diseased 
conditions  produced.  This  condition  is  very  com- 
mon as  the  natural  result  of  sedentary  habits  and 
corset-wearing. 


156  COLON  HYGIENE 

Feeble  Contraction  of  the  Abdominal 
Muscles 

When  the  abdominal  muscles  are  weak,  relaxed, 
separated,  or  otherwise  inefficient,  the  results  are 
the  same  as  when  the  diaphragm  fails  to  do  its 
duty,  for  the  two  sets  of  muscles  must  work  in  co- 
operation. 

The  ordinary  water-closet  seat  renders  complete 
efficiency  of  the  abdominal  muscles  and  diaphragm 
practically  impossible,  since  it  does  not  permit  of 
pressure  by  the  thighs,  an  essential  voluntary  act 
in   defecation. 

Deficient  Contraction  of  the  Colon 

A  feeble,  dilated,  inflamed,  thickened,  elongated, 
adherent,  overloaded,  obstructed  colon,  cannot 
possibly  contract  with  sufficient  vigor  to  empty  it- 
self of  its  unclean  contents.  Yet  such  is  the  chronic 
condition  of  the  colon  in  a  very  large  proportion 
of  cases  as  the  result  of  the  operation  of  some  one 
or  more  of  the  causes  which  have  been  enumerated 
in  the  foregoing  paragraphs. 

Nervousness,  apprehension  or  fear  may  prevent 
the  normal  reflex  from  acting.  Hysteria  or  melan- 
cholia may  paralyze  a  patient's  colon  as  well  as  an 
arm  or  a  leg. 

Injured  Levator  Ani  Muscles 

When  these  muscles  are  crippled  so  that  they 
cannot  contract  properly,  the  rectum  is  not  emptied 


.    DISORDERS  OF  THE  DIGESTIVE  TUBE     157 

but  remains  relaxed  and  filled  with  feces,  which 
give  rise  to  much  annoyance,  and  may  become  a 
cause  of  rectal  ulceration  and  hemorrhoids.  The 
levator  ani  muscles  are  often  damaged  by  lacera- 
tions at  childbirth,  or  by  the  prolonged  contact 
with  hardened  feces,  which  gives  rise  to  atrophic 
changes.  Laceration  of  the  perineum  permits  the 
pelvic  floor  and  anus  to  bulge  for^vard,  stretching 
the  rectum  and  thus  creating  a  wide  reservoir  for 
feces. 

Anal  Disease 

Pain  arising  from  ulcer,  fissure,  fistula  or  in- 
flamed hemorrhoids  may  cause  so  strong  a  con- 
traction of  the  anal  sphincters  that  they  fail  to  re- 
lax at  the  command  of  the  defecation  center,  so 
that  the  bowel  must  force  the  feces  down  through 
the  rectum  in  opposition  to  these  muscles.  This 
condition  exists  more  frequently  than  was  formerly 
supposed.  Many  cases  of  obstinate  constipation 
have  been  cured  by  an  operation  for  removal  of 
painful  hemorrhoids  or  relief  of  a  painful  ulcer  or 
fistula. 

Pregnancy,  extreme  retroversion  of  the  uterus, 
an  enlarged  and  painful  prostate,  malignant  or 
other  growths  in  or  about  the  rectum,  and  in  wo- 
men, rectocele,  from  laceration  of  the  perineum, 
are  causes  of  interference  with  the  proper  action 
of  the  defecating  mechanism. 

The  usual  result  of  this  defective  action  is   to 


158  COLON  HYGIENE 

leave  a  quantity  of  feces  in  the  rectum  or  the  pelvic 
colon  or  in  both  cavities.  The  retained  feces  be- 
come dry  and  hard,  sometimes  to  a  surprising  de- 
gree, and  form  a  mechanical  obstruction  v^^hich  re- 
sults in  a  damming  back  of  the  feces  which  are 
left  to  accumulate  in  sections  of  the  colon  higher 
up. 

Loss  of  Rectal  Reflex 

The  key  to  the  automatic  or  involuntary  act  of 
defecation  is  the  rectal  reflex,  which  is  discharged 
by  contact  of  the  feces  with  the  walls  of  the  rectum. 
The  long  retention  of  feces  in  contact  with  the 
rectal  nerves  destroys  their  sensibility  and  so  the 
reflex  is  lost.  This  is  one  of  the  worst  results  of 
the  disturbances  in  the  defecating  mechanism, 
which  have  been  above  enumerated.  Patients  suffer- 
ing with  this  form  of  constipation  often  report  that 
they  have  felt  no  desire  for  evacuation  of  the 
bowels  for  years.  The  loss  of  hearing,  or  even  of 
the  sense  of  sight,  would  really  be  less  of  a 
calamity  in  many  ca'ses  than  the  permanent  loss 
of  this  useful  reflex,  which  is  one  of  the  most  im- 
portant protective  mechanisms  with  which  the  body 
is  provided.  Fortunately,  however,  the  reflex 
generallj'^  may  be  restored. 

Disease  of  the  spinal  cord  may  permanently  de- 
stroy the  defecatory  center.  Constipation  is  some- 
times a  most  troublesome  symptom  in  locomotor 
ataxia. 


Alimentary  Toxemia  or  Intestinal 
Autointoxication  i 

Bouchard,  an  eminent  French  physician,  was 
first  to  coin  the  word  autointoxication,  and  to  point 
out  the  various  ways  in  which  the  disease  may  be 
produced  by  poisons  generated  in  the  body.  He 
called  special  attention  to  the  fact  that  the  intes- 
tine, and  especially  the  colon,  is  a  prolific  source 
of  poisons.  Some  of  these  poisons  are  excreted  by 
the  liver.  The  bile,  as  shown  by  Bouchard,  is  six 
times  as  poisonous  as  the  urine,  producing  poison 
enough  within  ten  hours  to  cause  death.  The 
mucous  membrane  of  the  intestine  has  been  shown 
to  be  another  source  of  highly  active  poisons, 
which  are  separated  from  the  blood  by  the  mucous 
membrane  and  thrown  into  the  cavity  of  the  in- 
testine to  be  removed  from  the  body. 

Still  another  source  of  intestinal  poisons  is  the 
putrefaction  of  that  portion  of  the  protein  of  the 
food  which  fails  to  undergo  absorption. 

The  bile,  mucous,  and  other  secretions  of  the 
intestine  and  the  adjacent  glands  also  undergo  put- 
refaction when  conditions  are  favorable. 

This  putrefactive  process  is,  as  shown  by 
Pasteur,  the  result  of  the  growth  of  certain  forms 
of  bacteria.  These  putrefactive  bacteria  are  found 
everywhere.      They    are    present    in    great    num- 

159 


160  COLON  HYGIENE 

bcrs  wherever  putrefaction  is  taking  place.  The 
flesh  of  every  dead  animal  is  filled  v\^ith  teeming 
millions  of  these  poison-forming  microbes  within  a 
few  hours  after  death.  A  piece  of  flesh  taken  from 
an  animal  just  killed,  and  placed  in  a  tightly  sealed 
glass  jar,  will  be  found  in  a  few  days  in  an 
advanced  state  of  putrefaction.  Experiments  of 
this  kind  were  made  by  Professor  Tissier  of  the 
famous  Pasteur  Institute  of  Paris.  He  found  it 
impossible  to  obtain  meat  so  fresh  that  it  did  not 
contain  bacteria  of  different  species  sufficient  to 
produce  complete  putrefaction.  As  ordinarily 
eaten,  the  flesh  of  animals  is  always  in  a  state  of 
more  or  less  advanced  putrefaction,  and  hundreds 
of  millions  of  living  bacteria  are  found  in  every 
morsel.  This  is  true  even  when  the  flesh  has 
been  cooked;  ordinary  cooking  does  not  destroy 
the  putrefactive  bacteria. 

Commercial  cow's  milk  also  abounds  with  bac- 
teria, some  of  which  are  of  putrefactive  sort.  Street 
dust  consists  very  largely  of  putrefactive  bacteria 
derived  from  animal  feces  which  have  been  drop- 
ped in  the  street  and  ground  into  dust  by  passing 
vehicles.  It  is  evident  then,  that  the  human  intes- 
tine is  very  greatly  exposed  to  infection  by  putre- 
factive bacteria;  and  it  needs  no  argument  to  show 
that  any  delay  of  food  residues  capable  of  putre- 
faction, together  with  the  bile,  mucus,  and  other 
constituents  of  the  feces,  must  result  in  the  pro- 
duction of  a  large  amount  of  intestinal  poison. 


ALIMENTARY  TOXEMIA  161 

In  view  of  these  facts,  it  is  safe  to  say  that  the 
worst  effects  of  constipation  are  those  which 
arise  from  intestinal  autointoxication.  Not  only 
Bouchard,  but  Tissier,  Combe,  Bourget,  Lane  of 
London,  and  a  great  number  of  able  medical  ex- 
perts in  all  parts  of  the  world  have  within  the  last 
few  5xars  recognized  the  great  and  far-reaching 
destructive  effects  of  the  absorption  of  bacterial 
poisons  from  the  intestinal  tract. 

It  is  entirely  possible  for  a  person  to  suffer  from 
intestinal  toxemia  without  constipation,  as  in 
cholera  morbus,  cholera  infantum  and  summer 
diarrhoeas  of  infancy;  but  it  is  impossible  to  have 
constipation  without  intestinal  autointoxication. 
The  fact  that  the  symptoms  of  toxemia  do  not  oc- 
cur in  every  case  is  no  evidence  that  they  are  not 
present.  The  body  must  be  unduly  exposed  to 
toxic  influences,  even  though  it  may  possess  to  such 
an  extraordinary  degree  the  power  to  defend  itself 
against  these  intestinal  poisons  that  immediate  visible 
effects  do  not  appear. 

When  the  intestinal  mucous  membrane  is  intact, 
it  is  able  to  exclude  most  of  the  intestinal  poisons, 
acting  like  a  filter,  which  permits  only  the  useful 
substances  to  enter  the  blood.  The  liver,  the 
largest  gland  in  the  body,  possesses  the  power  to 
destroy  poison  to  a  considerable  degree.  There 
are  various  other  organs  of  the  body,  such  as  the 
glands  of  internal  secretion,  of  which  the  thyroid 


162  COLON  HYGIENE 

gland  is  a  conspicuous  example,  which  aid  in  the 
destruction  of  poisons.  The  kidneys  both  destroy 
and  eliminate  poisons,  and  the  skin  and  the  lungs 
also  share  in  this  protective  work. 

So  long  as  the  defensive  powers  of  the  body  re- 
main intact,  enormous  quantities  of  poisons  may  be 
produced  in  the  intestine  without  apparently  evil 
results.  This  is  the  reason  why  many  constipated 
persons  seem  to  suffer  no  ill  effects  from  intestinal 
inactivity. 

In  every  case,  however,  the  time  comes  sooner 
or  later  when  the  intestinal  filter  no  longer  acts 
sufficiently  in  excluding  poisonous  matters — ^when 
the  liver  is  no  longer  able  to  destroy  all  the  poisons 
brought  to  the  blood;  when  the  thyroid  and  other 
glands  have  become  worn  out  with  over- activity ; 
when  the  kidneys  have  ceased  to  be  able  to  main- 
tain the  normal  degree  of  blood  purity  by  the  ex- 
cretion of  poisons. 

When  the  symptoms  of  toxemia  appear,  the  fact 
shows  that  the  poison-destroying  mechanism  of 
the  body  is  broken  down ;  the  great  margin  of  safety 
which  Nature  provides  against  emergencies,  has 
been  used  up;  the  defenses  against  autotoxins  have 
been  swept  away,  and  the  tissues  are  flooded  with 
these  subtle  and  mysterious  disease-producing  ele- 
ments. 

The  simple  and  latent  forms  of  constipation  are 
those  in  which  the  symptoms  of  toxemia  are  specially 
prominent,   for  the  reason   that  in  these   forms  of 


ALIMENTARY  TOXEMIA  163 

constipation  the  delay  occurs  in  those  portions  of 
the  digestive  canal  in  which  the  intestinal  contents 
are  still  fluid,  a  condition  in  the  highest  degree 
favorable  to  the  growth  of  putrefactive  bacteria. 
Besides  being  fluid,  the  contents  of  the  small  in- 
testine and  first  part  of  the  colon  contain  a 
varying  amount  of  protein,  the  food  element  on 
which  putrefactive  bacteria  thrive,  and  from  which 
alone  they  are  able  to  produce  their  deadly  toxins. 

In  cumulative  constipation,  the  protein  is  almost 
wholly  absorbed  before  the  lower  colon  is  reached, 
and  the  amount  of  water  is  reduced  to  such  an 
extent  that  putrefaction  is  necessarily  limited,  and 
the  resulting  autointoxication  is  proportionately 
less. 

In  latent  constipation,  especially,  the  conditions 
are  in  a  high  degree  favorable  for  the  development 
of  intestinal  autointoxication.  The  stasis  or  stag- 
nation above  the  ileocecal  valve  affords  conditions 
the  most  favorable  for  putrefaction  and  absorption 
of  putrefactive  products.  It  is  evident,  then,  that 
the  study  of  constipation  cannot  be  complete  with- 
out a  thorough  study  of  intestinal  toxemia.  This 
is  especially  true  as  regards  the  treatment  of  this 
condition  both  with  reference  to  the  causes  of  the 
constipation  and  its  consequences. 

Bacteria  of  the  Intestine 

Roger,  the  eminent  successor  of  Bouchard,  de- 
scribed no  less  than  one  hundred  sixty  different  spec- 


164      '  COLON  HYGIENE 

ies  of  bacteria  which  have  been  found  in  the  alimen- 
tary canal.  Many  of  these  produce  no  poisons.  Others 
produce  simple  organic  acids  which  are  under  or- 
dinary circumstances  harmless;  still  others  produce 
alcohol,  formic  acid,  butyric  acid,  and  other  sub- 
stances which  are  unquestionably  toxic,  although 
not  appreciably  so  in  the  extremely  minute  quanti- 
ties in  which  they  are  produced  in  the  intestine 
under  strictly  normal  conditions.  Still  other  mi- 
crobes, of  which  some  scores  of  species  are  found 
in  the  intestine,  produce  subtle  poisons  which  are 
capable  of  causing  deadly  effects,  even  in  very 
minute  quantities.  Everj^one  is  familiar  ■with  the 
unpleasant  effects  of  the  volatile  substances  which 
emanate  from  a  mass  of  putrefying  flesh.  Head- 
ache, nausea,  and  other  s)Tiiptoms  may  result  from 
the  odors  alone  which  arise  from  putrescent  sub- 
stances. These  volatile  substances  are  poisonous, 
but  other  non-volatile  poisons  present  are  much  more 
active.  Some  are  almost  as  powerful  as  the  venoms 
of  snakes,  which  they  resemble  in  chemical  composi- 
tion. The  South  American  Indian  poisons  the 
points  of  his  deadly  arrows  by  dipping  thern  into 
putrid  flesh.  Butchers  as  well  as  undertakers  some- 
times die  as  the  result  of  a  small  cut  made  with  a 
knife  soiled  by  contact  with  a  dead  body.  The 
same  poisons  are  produced  when  putrefaction  takes 
place  in  the  intestine. 

None  of  the  Intestinal  microbes  are  essential  for 
life  or  health.     Pasteur  supposed  that  all  life  was 


ALIMENTARY  TOXEMIA  165 

dependent  upon  microbes.  One  of  his  pupils, 
Roux,  showed  this  idea  to  be  erroneous,  at  least  as 
regards  vegetables,  by  causing  beans  to  grow  in 
sterile  soil  and  sterile  water.  Pasteur  admitted  his 
error  in  regard  to  vegetable  organism,  but  still 
maintained  that  animals  could  not  live  without  the 
aid  of  intestinal  bacteria.  Nuttall  and  Thierfelder, 
by  experiments  with  guinea  pigs,  showed  that  these 
animals  could  be  brought  into  the  world  free  from 
germs,  and  made  to  grow  on  food  which  contained 
no  trace  of  bacteria.  When  ths  animals  were  killed, 
no  bacteria  were  found  in  their  intestines.  Recent 
experiments  made  by  Roux  showed  that  chickens 
hatched  and  grown  under  sterile  conditions  thrived 
better  than  chickens  hatched  under  ordinary  condi- 
tions. 

Numerous  other  experiments  have  confirmed 
this  fact,  but  most  important  of  all  were  the  obser- 
vations of  Levin  at  Spitzbergen,  in  the  Arctic  reg- 
ion. This  observer  made  careful  examination  of 
scores  of  Arctic  animals,  and  found  that  in  the 
majority  of  cases  no  bacteria  were  present  in  the 
intestine.  This  fact  will  be  easily  understood 
when  the  additional  fact  is  known  that  the  air,  and 
even  sea-water,  are  in  these  cold  regions  practically 
free  from  bacteria. 

The  fact  that  bacteria  are  present  in  the  human 
intestine  is  therefore  no  evidence  that  they  supply 
any  human  need.  The  presence  of  these  minute 
parasites  is,  instead,  an  unfortunate  incident  of  our 


166  COLON  HYGIENE 

existence.  MetchnikofiE  has  shown  that  colon  germs 
in  no  way  contribute  to  our  well-being,  but  on  the 
contrar}^,  are  an  undoubted  cause  of  premature 
senility,  and  the  unnatural  abbreviation  of  human 
life,  the  sad  lot  of  the  average  man. 

Acid-Forming  Bacteria 

Professor  Tissier,  of  Paris,  well  known  as  one 
of  the  leading  savants  of  the  renowned  Pasteur 
Institute,  many  years  ago  made  a  profound  study  of 
the  bacteria  of  the  intestine  and  established  the 
fact,  which  had  been  previously  observed  by  Es- 
cherich  and  others,  that  the  intestine  of  a  new  bom 
babe  is  absolutely  free  from  bacteria.  Tissier  made 
an  extended  research  of  the  manner  of  the  invasion 
of  the  intestine  of  the  j^oung  child  by  bacteria.  He 
found  that  within  about  seven  hours  in  summer 
time,  and  twent}'  hours  in  winter  time,  when  bac- 
teria are  less  abundant  in  the  air,  the  intestine  of 
the  recently  bom  child  is  found  to  be  swarming 
with  bacteria,  many  of  which  are  of  the  putrefactive 
sort.  Within  a  few  days,  however,  the  putrefactive 
bacteria  disappear,  and  a  peculiarh'^  shaped  acid- 
forming  microbe,  to  which  Professor  Tissier  gave 
the  name  Bacillus  bifidus,  takes  their  place. 

This  observation  w^as  of  the  greatest  importance. 
It  reveals  the  beneficent  plan  of  Nature,  by  which 
the  young  infant  is  protected  from  the  deadly  effects 
of  putrefactive  organisms.     So  long  as  the  Bacillus 


ALIMENTARY  TOXEMIA  167 

bifidus  continues  to  hold  its  place  as  the  dominant 
microbe  of  the  child's  intestine,  the  stools  are  slightly 
acid  and  the  little  one  enjoys  perfect  health.  The 
child's  intestine  may  be  compared  to  a  flower 
garden  which  is  so  completely  occupied  by  flowers 
that  there  is  no  room  for  the  growth  of  noxious 
weeds. 

As  the  child  becomes  older,  and  is  fed  upon 
cow's  milk,  meat,  and  other  foodstuffs  which  con- 
tain putrefactive  organisms,  and  is  no  longer  nursed 
at  the  breast,  the  Bacillus  bifidus  becomes  less  promi- 
nent in  the  stools,  putrefactive  bacteria  make  their 
appearance,  the  child  becomes  subject  to  constipa- 
tion and  diarrhoeas,  and  the  troubles  of  life  begin. 
The  stools,  instead  of  being  acid,  acquire  a  foul 
odor.  In  many  instances,  such  symptoms  of  chronic 
autointoxication,  as  rickets,  scurvy,  arrested  growth, 
emaciation,  decay  of  the  teeth,  nasal  catarrh,  and 
other  evidences  of  physical  weakness  make  their 
appearance. 

Infantile  convulsions,  night  terrors,  grinding  the 
teeth  during  sleep,  fitfulness,  feverishness,  and  num- 
erous other  symptoms  of  nervous  disturbance  in 
infants,  are  directly  due  to  poisoning  as  the  result  of 
constipation,  with  intestinal  putrefaction.  So  long 
as  the  stool  remains  normally  acid,  constipation 
does  not  occur,  but  when  putrefaction  and  foul- 
smelling  feces  occur  then  constipation  appears  with 
a  great  variety  of  nervous  and  other  symptoms  which 
are  a  natural  consequence. 


168  COLON  HYGIENE 

A  few  years  ago  Massol,  of  Geneva,  in  study- 
ing certain  Bulgarian  milk  preparations  discovered 
a  new  lactic-acid-forming  ferment.  In  testing  its 
properties  he  discovered  that  it  possessed  the  faculty 
of  producing  lactic  acid  in  far  greater  quantities  than 
any  other  known  ferment.  The  eminent  Professor 
Metchnikoff,  of  the  Pasteur  Institute,  at  once  recog- 
nized the  value  of  this  new  discovery,  and  after  a 
careful  study  of  the  ferment,  did  not  hesitate  to 
recommend  it  as  a  most  important  means  of  com- 
bating many  of  the  gravest  forms  of  chronic  disease, 
and  especially  that  most  inveterate  of  all  human 
maladies,  old  age. 

Professor  Metchnikofi  has  long  held  the  theory 
that  old  age,  as  well  as  many  common  chronic  dis- 
orders, is  due  to  poisons  absorbed  from  the  intes- 
tines. These  poisons  are  formed  by  certain  germs 
known  as  ansrobes.  Some  of  these  germs  are  found 
in  such  great  quantities  in  butcher's  meat  that  Herte*" 
has  given  to  them  the  name  "meat  bacteria."  By 
the  use  of  meat  these  germs  are  introduced  Into 
the  intestine  in  great  numbers.  The  poisons  formed 
by  these  germs  are  extremely  virulent,  and  when 
taken  into  the  body,  gradually  break  down  the 
liver,  kidneys,  and  other  defensive  organs,  and  so 
give  rise  to  a  large  number  of  very  common  and 
very  serious  diseases.  This  chronic  poisoning  first 
makes  its  appearance  in  acute  attacks,  such  as  sick 
headache,  nervous  headache,  loss  of  appetite,  coated 
tongue,    bilious    attacks,    irregular    action    of    the 


•  -  c  _ 

'S  S  7? 
o  o  J: 


ALIMENTARY  TOXEMIA  169 

bowels,  diarrhea,  appendicitis,  febrile  attacks  resem- 
bling malaria,  and  insomnia. 

As  the  system  becomes  more  and  more  saturated 
with  these  poisons  through  the  gradual  failure  of 
the  liver  and  kidneys  and  the  constant  multiplication 
of  the  bacteria,  other  more  chronic  symptoms  appear, 
such  as  constant  headache,  mental  confusion,  neuras- 
thenia, nervous  exhaustion,  gall-stones,  hemorrhoids, 
emaciation,  browning  of  the  skin,  particularly  about 
the  eyes,  various  skin  diseases,  especially  acne,  ec- 
zema, psoriasis  and  urticaria,  neuralgia,  pain  and 
stiffness  of  the  joints.  After  a  time  still  worse  con- 
ditions make  their  appearance,  such  as  Bright's  dis- 
ease, sclerosis  or  hardening  of  the  liver,  dropsy, 
chronic  rheumatism,  and  rheumatic  gout. 

Chronic  autointoxication  is  unquestionably  a 
factor  in  nearly  all  chronic  disorders,  and  lays  the 
foundation  for  tuberculosis,  cancer  of  the  stomach, 
ulcer  of  the  stomach,  and  other  gastric  disorders. 
Many  women  supposed  to  be  suffering  from  dis- 
orders peculiar  to  their  sex,  are  really  suffering  only 
from  autointoxication,  which  is  the  natural  result 
of  prolapse  of  the  viscera,  colitis,  and  inattention  to 
the  hygiene  of  the  bowels. 

It  has  long  been  known  that  the  conditions  above 
mentioned  may  be  greatly  relieved  by  the  use  of 
buttermilk  and  kumyss,  but  these  remedies  have 
never  gained  very  great  confidence  for  the  rea- 
son that,  while  they  have  seemed  to  succeed  remark- 
ably in  certain  cases,  in  the  majority  of  cases  the 


170  COLON  HYGIENE 

relief  obtained  has  been  very  temporary,  and  often 
their  use  has  been  attended  by  complete  failure. 
The  reason  for  this  was  the  fact  that  the  lactic  fer- 
ment of  kumyss  and  buttermilk  is  not  able  to  live 
in  the  large  intestine.  This  is  the  particular  part 
of  the  alimentary  canal  in  which  the  poison-forming 
anaerobes  are  found  in  largest  numbers,  especially  in 
the  cecum. 

Tissier's  experiments  showed  that  the  Bulgarian 
lactic  ferment  has  such  great  vitality  that  it  is  able  to 
live  in  the  colon.  Its  great  activity  in  the  formation 
of  acids  enables  it  to  kill  off  the  anaerobes  which  can 
live  only  in  an  alkaline  medium.  Fortunately  the 
new  ferment  is  harmless,  so  that  a  person  who  is 
suffering  from  autointoxication  may,  by  introducing 
into  his  alimentary  canal  a  sufficient  amount  of  the 
lactic  ferment,  drive  out  the  poison-forming  germs, 
or  at  least  reduce  their  numbers  to  a  very  great  ex- 
tent. The  importance  of  doing  this  will  be  realized 
when  it  is  known  that  the  poisons  which  they  form 
are  among  the  most  highly  toxic  known.  This  is  the 
reason  that  constipation  produces  headache,  and  that 
diarrhea  is  accompanied  by  such  great  exhaustion. 
The  headache  and  the  prostration  are  simply  results 
of  the  poisons  which  are  absorbed  from  the  infected 
intestines. 

This  ferment  has  been  known  for  ages  in  Bul- 
garia and  the  Orient  generally.  In  Egypt  it  is 
known  as  leben.  In  these  countries  a  milk  prepara- 
tion containing  the  ferment  is  prepared  by  steriliz- 


ALIMENTARY  TOXEMIA  171 

ing  the  milk  and  adding  the  ferment  to  it.  It 
possesses  the  particular  advantage  that  it  does  not 
produce  alcohol  as  does  the  kumyss  ferment,  and 
when  properly  cultivated,  it  does  not  produce  dis- 
agreeable flavors  by  decomposing  the  caseins  and 
fats  of  the  milk. 

The  use  of  the  ferment  has  extended  rapidly  in 
France  and  Sw^itzerland,  and  has  lately  been  intro- 
duced into  this  country.  For  those  w^ho  like  milk 
and  are  able  to  digest  it  readily,  the  milk  prepara- 
tion is  very  satisfactory,  although  the  preparation 
of  the  milk  requires  considerable  care  and  pains  to 
prevent  contamination.  There  are  many,  however, 
with  whom  milk  does  not  agree.  Such  persons 
have  been  termed  by  Combe  "casein  dyspeptics." 
For  the  benefit  of  such  cases  concentrated  prepa- 
rations of  the  ferment  have  been  devised.  Pure 
cultures  of  the  ferment  are  made  in  a  bacteriological 
laboratory  and  in  concentrated  form  are  made  into 
tablets.  Three  or  four  of  these  tablets  taken  after 
or  at  meals  in  connection  with  a  proper  dietary, — 
especially  with  the  free  use  of  farinaceous  foods,  and 
maltose  in  the  form  of  malt  extracts  or  meltose — 
develop  rapidly,  and  by  driving  out  the  invading 
anaerobes,  stop  the  formation  of  poisons  and  give  the 
body  an  opportunity  to  clear  itself  from  the  accumu- 
lated toxins,  and  thus  establish  conditions  which 
Tender  recovery  possible.  Those  who  like  milk,  but 
do  not  like  it  sour,  may  take  it  in  its  ordinary  form, 
adding  the  tablets. 


172  COLON  HYGIENE 

It  is,  of  course,  evident  that  a  person  adopting^ 
this  method  should  discontinue  the  use  of  meat  en- 
tirely, and  should  not  use  eggs  freely. 

Ancient  Latin  authors  mention  the  use  of  sour 
milk  preparations  by  the  primitive  tribes  which  occu- 
pied the  country  now^  inhabited  by  the  Bulgarians 
and  other  Balkan  people  by  whom  the  Bulgarian 
ferment    is   widely   used. 

The  natives  of  Mesopotamia,  living  about  Mount 
Ararat  make  large  use  of  the  same  ferment,  which 
they  declare  was  preserved  for  them  by  the  antedilu- 
vian Noah;  and  it  is  certain  that  this  ferment  and 
buttermilk  prepared  fromi  it  was  well  known  to 
Abraham  and  the  other  Hebrew  patriarchs  whose 
use  of  it  is  mentioned  in  the  Scriptures. 

Natives  of  northern  India  make  large  use  of  a 
sour  milk  preparation  called  dahi.  An  examina- 
tion of  a  sample  of  this  preparation,  sent  to  us  from 
a  friend  living  in  Darjeeling,  India,  showed  that  it 
contained  an  acid-forming  organism  identical  with 
the  Bacillus  Bulgaricus.  A  few  years  ago  a  medical 
friend  whom  the  author  met  in  Edinburgh,  Dr. 
Matthieason,  of  Iceland,  described  to  him  a  sour  milk 
preparation  used  in  that  country,  known  as  "skyr," 
which  is  made  by  first  adding  to  the  milk  a  "starter," 
to  which  rennin  is  then  added  to  curdle  it.  The 
curd  is  separated  from  the  whey  and  packed  in  casks 
or  barrels.  Melted  paraffin  is  poured  over  the  sur- 
face to  preserve  it.  In  this  way  it  is  kept  for  many 
months,  and  is  a  valuable  source  of  food  in  the  win- 


ALIMENTARY  TOXEMIA  175 

ter  season  when  milk  is  scarce.  Doctor  Matthieason 
states  that  this  product  is  found  a  highly  efficient 
remedy  in  relieving  acute  gastric  and  intestinal  dis- 
orders due  to  excessive  meat-eating  v^hich  is  very 
common  in  Iceland.  A  bacteriological  study  of  skyr 
made  in  the  laboratory  of  the  Battle  Creek  Sani- 
tarium showed  that  it  contains  an  acid-forming 
organism  resembling  the  Bacillus  Bulgaricus  which 
grows  very  vigorously  and  produces  large  quantities 
of  lactic  acid. 

It  thus  appears  that  the  use  of  lactic  acid  ferments 
13  a  practice  known  to  widely  scattered  nations  and 
from  the  most  ancient  times.  The  great  care  which 
is  taken  by  the  most  primitive  people  to  preserve  the 
purity  of  the  particular  ferment  which  they  employ, 
and  the  high  value  which  they  place  upon  it  in  the 
treatment  of  many  diseases,  leads  one  to  wonder 
that  civilized  people  should  have  been  so  slow  to 
avail  themselves  of  this  valuable  means  of  com- 
batting some  of  the  most  dangerous  and  insidious 
of  the  foes  of  human  life. 

Alimentary  Toxemia 

The  condition  known  as  intestinal  autointoxica- 
tion, intestinal  toxemia,  and  more  recently  termed 
alimentary  toxemia,  is  one  of  the  natural  and  most 
far-reaching  consequences  of  constipation  and  intes- 
tinal stasis.  All  foodstuffs  are  capable  of  under- 
going destructive  change  as  the  result  of  the  action 


176  COLON  HYGIENE 

blood  vessels  and  cause  first  contraction,  then  hare  - 
ening  and  degeneration,  or  arteriosclerosis.  The 
brain  and  nerves  show  evidences  of  depression  or 
irritation,  according  to  the  nature  of  the  dominat- 
ing poisons.  Headaches,  neuralgia,  neuritis,  paraly- 
sis, mental  dullness,  neurasthenia,  even  insanity, 
are  the  results.  Diseases  of  the  liver,  thyroid  gland 
and  spleen  develop.  Skin  diseases  of  various  kinds, 
and  every  sort  of  bodily  derangement,  are  seen. 


Important   Discussion  of  Alimen- 
tary     Toxemia      Before    the 
Royal    Society    of    Medi- 
cine of  Great  Britain 

About  two  years  ago  the  subject  of  alimentary 
toxemia  was  discussed  in  London  before  the  Royal 
Society  of  Medicine,  by  fifty-seven  of  the  leading 
physicians  of  Great  Britain.  Among  the  speakers 
were  eminent  surgeons,  physicians,  and  specialists  in 
the  various  branches  of  medicine. 

Poisons  of  Alimentary  Intestinal  Toxemia 

The  following  is  a  list  of  the  various  poisons 
noted  by  the  several  speakers:  Indol,  skatol,  phenol, 
cresol,  indican,  sulphuretted  hydrogen,  ammonia, 
histidine,  urobilin,  methylmercaptan,  tetramethy- 
lendiamin,  pentamethylendlamine,  putrescin,  cadav- 
erin,  lecithin,  neurin,  cholin,  muscarine,  butyric 
acid,  beta-imidazolethylamine,  methylgadinine, 
ptomatropine,  botulin,  mytilotoxin,  mytilo-conges- 
tine,  oxybetaine,  tyramine,  agmatine,  tryptophane, 
sepsin,  indolethylamine,  sulphemoglobine. 

Of  the  thirty-six  poisons  mentioned  above,  several 
are  highly  active,  producing  most  profound  effects, 
and  in  very  small  quantities.  In  cases  of  alimentary 
toxemia  some   one   or   several   of   these   poisons   is 

177 


178  COLON  HYGIENE 

constantly  bathing  the  delicate  body  cells,  and 
setting  up  changes  which  finally  result  in  grave 
disease. 

Symptoms  said  Diseases  Due  to  Alimentary^ 
Toxemia 

It  should  be  understood  that  these  findings  are 
not  mere  theories,  but  are  the  results  of  demonstra- 
tion in  actual  practice  by  eminent  physicians.  Of 
course  it  is  not  claimed  that  alimentary  toxemia 
is  the  only  cause  of  all  the  symptoms  and  diseases 
nam.ed:  Although  of  many  it  may  be  the  sole  or 
principal  cause,  some  of  them  are  due  to  other  causes 
as  well. 

In  the  following  summary  the  various  symptoms 
and  disorders  mentioned  in  the  discussion  in  Lon- 
don, to  which  reference  has  been  made  above,  are 
grouped  and  classified. 

The  Digestive  Organs 

Duodenal  ulcer  causing  partial  or  complete  ob- 
struction of  the  duodenum;  pyloric  spasm;  p34oric 
obstruction;  distension  and  dilatation  of  the 
stomach ;  gastric  ulcer ;  cancer  of  the  stomach ;  ad- 
hesions of  the  omentum  to  the  stomach  and  liver; 
inflammation  of  the  liver;  cancer  of  the  liver. 

The  muscular  wall  of  the  intestine  as  well  as 
other  muscles,  atrophies,  so  that  the  passage  of  their 
contents  is  hindered.     The  abdominal  viscera  lose 


Healthy    and    Hardened    Arteries 


Hoi^HR>L     ai^TEi^Y 


cHhoH\c    wte^\t\s 


Sectional   View  of   a   Healthy   Artery   and   Arteriosclerosis 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    179 

their  normal  relationship  to  the  spine  and  to  each 
■other,  on  account  of  weakening  of  the  abdominal 
muscles;  these  displacements  are  much  more  marked 
and  serious  in  women.  Other  conditions  are: 
Catarrh  of  the  intestines;  foul  gases  and  foul- 
smelling  stools;  colitis;  acute  enteritis;  appendicitis, 
acute  and  chronic;  adhesions  and  "kinks"  of  the 
intestine;  visceroptosis;  enlargement  of  spleen; 
distended  abdomen;  tenderness  of  the  abdomen; 
summer  diarrhoea  of  children;  inflammation  of 
pancreas;  chronic  dragging  abdominal  pains;  gas- 
tritis; cancer  of  pancreas;  inflammatory  changes  of 
gall-bladder;  cancer  of  gall-bladder;  gallstones; 
degeneration  of  liver;  cirrhosis  of  liver;  infection  of 
the  gums,  and  decay  of  the  teeth;  ulcers  in  the 
mouth  and  pharynx. 

Heart  and  Blood- Vessels 

Wasting  and  weakening  of  the  heart  muscle; 
microbic  cyanosis  from  breaking  up  of  blood  cells; 
fatty  degeneration  of  the  heart;  endocarditis;  myo- 
carditis; subnormal  blood  pressure;  enlargement  of 
the  heart;  the  dilitation  of  the  aorta;  high  blood 
pressure;  arteriosclerosis;  permanent  dilatation  of 
arteries. 

Dr.  W.  Bezley  says:  "There  are  a  few  phases 
of  cardiovascular  trouble  (disease  of  heart  and 
blood  vessels)  with  which  disorder  of  some  part 
<of  the  alimentary  tract  is  not  causatively  associated." 


180  COLON  HYGIENE 

TSie  Nervous  System 

Headaches  of  various  kinds — frontal,  occipital, 
temporal,  dull  or  intense,  hemicrania;  headache  of 
a  character  to  lead  to  a  mistaken  diagnosis  of  brain 
tumor.  Dr.  Lane  tells  of  a  case  where  a  surgeon 
had  proposed  an  operation  for  the  removal  of  a 
tumor  from  the  frontal  lobe  of  the  brain;  the  diffi- 
culty was  wholly  removed  by  the  exclusion  of  the 
colon.  Acute  neuralgia  pains  in  the  legs;  neuri- 
tis; twitching  of  the  eyes  and  of  muscles  of  face, 
arms,  legs,  etc.  Lassitude;  irritability;  disturbances 
of  nervous  system,  varying  from  simple  headaches 
to  absolute  collapse;  mental  and  physical  depression. 
"A  medical  man  with  neurasthenic  symptoms  and 
a  belief  that  he  was  ruined,  recovered  after  he  left 
off  taking  an  egg  for  breakfast."  Insomnia; 
troubled  sleep,  unpleasant  dreams;  unrefreshing 
sleep,  the  patient  awakening  tired;  excessive  sleep- 
iness, patient  falling  asleep  in  the  daytime;  shivery 
sensations  across  lower  spinal  region;  burning  sen- 
sations in  face,  hands,  etc;  epileptiform  tic;  typhoid 
state;  paralysis;  chronic  fatigue;  horror  of  noises; 
morbid  introspection;  perverted  moral  feelings; 
melancholia,  mania,  loss  of  memory;  difficulty  of 
mental  concentration;  imbecility;  insanity;  delir- 
ium, coma. 

The  Eyes 

Degenerative  changes  in  the  eye;  inflammation 
of  the  lens;  inflammation  of  the  optic  nerve;  hard- 


Gall  Stones 


Ulcer  of  the  Stomach  Cirrhosis  of  the  Liver 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    181 

ening  of  the  lens;  sclerotitis,  sclerokeratitis ;  iritis > 
iridocyclitis;  cataract;  recurrent  hemorrhage  in  the 
retina;  eyes  dull  and  heavy.  W,  Long  says:  "As 
an  ophthalmic  surgeon,  I  can  look  forward  full 
of  hope  to  a  future  when  those  serious  eye  affec- 
tions will  cease  to  occur,  because  the  physician  has 
taught  mothers  how  to  feed  children  properly,  and 
the  dental  surgeon  has  impressed  upon  the  popula- 
tion at  large  the  importance  of  proper  mastication 
and  the  hygiene  of  the  mouth." 

The  Skin 

Formation  of  wrinkles;  thin,  inelastic,  starchy 
skin;  pigmentation  of  the  skin — yellow,  brown, 
slate-black,  blue;  muddy  complexion;  offensive  se- 
cretion from  skin  of  flexures;  thickening  of  the 
skin  of  the  back  of  the  upper  arm;  irritability  of 
the  skin;  sweating  of  the  palms  of  the  hands  and 
the  soles  of  the  feet;  eruptions  of  the  skin — sores 
and  boils;  pemphigus;  pruritus;  herpes;  eczema; 
dermatitis;  lupus  erythematosus;  acne  rosacea;  cold, 
clammy  extremities;  dark  circles  under  the  eyes; 
seborrhoea;  psoriasis;  pityriasis;  alopecia;  lichen; 
planus;  jaundice;  "An  infinitesimal  amount  of 
poison  may  suffice  to  cause  skin  eruption." 

Muscles  and  Joints 

Degeneration  of  the  muscles;  "Muscles  waste 
and  become  soft  and  in  advanced  cases  tear  easily." 


182  COLON  HYGIENE 

^*In  young  life  the  muscular  debility  produces  the 
deformities  which  are  called  dorsal  excurvation,  or 
round  shoulders,  lateral  curvature,  flat-foot,  and 
knock-knee."  "Weakness  of  abdominal  muscles 
causes  accumulation  of  feces  in  the  pelvic  colon, 
■which  renders'  evacuation  of  contents  more  and 
more  difficult."  Prominence  of  bones;  rheumatic 
pains  simulating  sciatica  and  lumbago;  various  mus- 
cular pains;  muscular  rheumatism;  arthritis  de- 
formans; synovitis;  rickets;  arthritis,  acute  and 
chronic.  Tubercle,  and  rheumatoid  arthritis  are 
the  direct  result  of  intestinal  intoxication.  Dr.  Lane 
says :  "I  do  not  believe  it  is  possible  for  either  of 
these  diseases  to  obtain  a  foothold  except  in  the 
presence  of  stasis." 

Genito-Urinary  and  Reproductive  Organs 

Various  displacements,  distortions  and  diseases  of 
the  uterus ;  change  in  the  whole  form  and  contour  of 
woman;  fibrosis  of  breast;  wasting  of  breasts;  in- 
duration of  breasts;  sub-acute  and  chronic  masti- 
tis; cancer  of  breast;  metritis  and  endometritis;  in- 
fection of  bladder  especially  in  women;  frequent 
urination;  albumosuria;  acute  nephritis,  movable 
kidney;  floating  kidney.  Dr.  Lane  goes  so  far  as 
to  say:  "Autointoxication  plays  so  large  a  part  in 
the  development  of  diseases  of  the  female  genito- 
urinary apparatus,  that  they  may  be  regarded  by  the 
gynecologist  as  a  product  of  intestinal  stasis." 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    183 

General  Disorders  and  Disturbances  of 
Nutrition 

Degeneration  of  the  organs  of  elimination,  es- 
pecially the  liver,  kidneys  (Bright's  disease)  and 
spleen;  pernicious  anemia;  lowered  resistance  to  in- 
fection of  all  kinds;  premature  senile  decay;  retar- 
dation of  growth  in  children,  accompanied  by  men- 
tal irritability  and  muscular  fatigue;  adenoids;  en- 
larged tonsils;  scurvy;  enlarged  thyroid  (goitre)  ; 
various  tumors  of  thyroid;   Raynaud's  disease. 

In  those  who  apparently  suffer  no  harm  from 
constipation  during  a  long  series  of  years  there  is 
perhaps,  as  suggested  by  Hertz,  a  partial  immuni- 
ty established.  The  writer  has  long  believed  that 
such  an  immunity  is  sometimes  established  in  the 
very  obstinate  constipation  which  accompanies  abso- 
lute fasting,  because  of  the  cleansing  of  the  tongue 
and  reappearance  of  appetite  which  often  occurs 
at  the  end  of  the  second  or  third  week  of  the  fast, 
a  phenomenon  very  like  that  which  appears  in  ty- 
phoid fever  and  other  continued  fevers.  It  must 
not  be  supposed,  however,  that  even  the  establish- 
ment of  so-called  immunity  insures  the  body  against 
all  injury.  The  labor  of  eliminating  an  enormous 
amount  of  virulent  toxins,  which  falls  upon  the 
kidneys,  damages  the  renal  tissues  and  produces 
premature  failure  of  these  essential  organs.  Any 
process  which  develops  toxins  within  the  body  is 
a  menace  to  the  life  of  the  tissues  and  should  be 


184  COLON  HYGIENE 

suppressed  as  far  as  possible,  and  as  quickly  as  pos- 
sible. 

The  fact  that  symptoms  of  poisoning  resulting 
from  constipation  do  not  apear  at  once  is  no  evidence 
that  injury  is  not  done.  Dr.  Wm.  Hunter  in  the 
course  of  the  London  discussion  remarked  that 
the  fact  that  chronic  constipation  "might  exist 
in  certain  individuals  as  an  almost  permanent  con- 
dition without  apparently  causing  ill-health  is  due 
solely  to  the  powder  and  protective  action  of  the 
liver.  It  is  not  any  evidence  of  the  comparative 
harmlessness  of  constipation  per  se,  but  only  an 
evidence  that  some  individuals  possess  the  cecum 
and  the  colon  of  an  ox,  vv^ith  the  liver  of  a  pig, 
capable  of  doing  any  amount  of  distoxication." 

In  the  face  of  such  an  array  of  evidence  backed. 
M^  by  authority  of  nearly  sixty  eminent  English 
physicians — and  many  hundreds  of  other  English, 
German,  and  French  physicians  w^hose  names  might 
be  added — it  is  no  longer  possible  to  ignore  the 
importance  of  alimentary  toxemia  or  autointoxica- 
tion as  a  factor  in  the  production  of  disease.  To 
no  other  single  cause  is  it  possible  to  attribute  one- 
tenth  as  many  various  and  vi^idely  diverse  disorders. 
It  may  be  said  that  almost  every  chronic  disease 
known  is  directly  or  indirectly  due  to  the  influence 
of  bacterial  poisons  absorbed  from  the  intestine. 
The  colon  may  be  justly  looked  upon  as  a  veritable 
Pandora's  box,  out  of  which  come  more  human 
misery  and  suffering  mental  and  moral  as  well  as 
physical  than  from  any  other  known  source. 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    185 

The  successful  treatment  of  alimentary  toxemia 
often  taxes  to  the  utmost  the  resources  of  the  best 
equipped  physician.  Sometimes  it  is  necessary  to 
call  in  the  services  of  the  surgeon. 

It  may  be  fairly  said,  however,  that  at  least 
nine-tenths  of  the  possible  benefits  to  be  derived 
from  treatment  is  to  be  secured  by  combating  in- 
testinal stagnation.  By  such  regulation  of  diet 
and  habits  as  to  secure  a  thorough  evacuation  of 
the  bowels  at  least  three  times  a  day,  or  after  each 
meal,  and  by  excluding  from  the  diet  flesh  meats  and 
other  putresicible  substances,  more  can  be  accom- 
plished toward  eliminating  from  the  intestine  per- 
nicious parasitic  organisms  and  the  multitudinous 
poisons  which  they  produce  than  all  other  means. 

The  sources  of  the  poison-forming  bacteria 
which  grow  in  the  human  intestine  are  numerous. 
It  is  probable,  however,  that  butcher's  meat,  fish, 
oysters  and  other  shellfish  are  the  chief  sources,  for 
Tissier  found  that  when  he  obtained  flesh  from 
the  slaughterhouse  in  as  fresh  a  condition  as  pos- 
sible, it  contained  all  the  bacteria  necessary  to  pro- 
duce active  putrefaction,  which  was  made  evident 
to  the  sense  of  smell  within  twenty-four  hours,  and 
became  more  and  more  pronounced  from  day  to 
day. 

Bacteriologists  have  shown  that  the  mouth  al- 
ways contains  putrefactive  bacteria.  The  normal 
stomach  is  sterile  during  digestion,  because  the  gas- 
tric juice   is  a  powerful   germicide    and    destroys 


186  COLON  HYGIENE 

them;  but  in  stomachs  which  do  not  produce  a  suffi- 
cient amount  of  gastric  juice,  and  in  normal 
stomachs  when  empty  of  food,  great  numbers  o£ 
these  dangerous  microbes  may  be  found. 

Below  the  stomach  the  number  of  bacteria  in- 
crease. At  the  lower  end  of  the  small  intestine, 
and  in  the  caecum,  the  number  of  living  bacteria 
is  the  greatest. 

The  reason  for  this  is  the  presence  of  food  resi- 
dues and  body  wastes  of  character  suitable  to  en- 
courage the  growth  of  putrefactive  bacteria,  while 
starch  and  sugar  which  are  needed  for  the  growth 
of  acid-forming  organisms  are  absent,  having  been 
digested  and  absorbed  in  the  small  intestine. 

Changing  the  Intestinal  Flora 

Many  people  seek  by  change  of  climate,  often 
at  great  expense  and  inconvenience,  to  secure  re- 
lief from  ailments  which  only  require  a  change  of 
the  character  of  the  bacteria  growing  in  their  in- 
testines and  are  to  no  appreciable  extent  affected 
by  the  climatic  influences.  If  sometimes  relief  is 
found  by  such  persons  in  a  change  of  climate  it  is 
because  an  incidental  change  of  their  intestinal 
bacterial  growth  happens  to  occur  at  the  same 
time.  "Bilious"  climates  do  not  exist.  "Bilious- 
ness," an  unscientific  but  significant  and  useful 
word,  signifies  conditions  that  can  be  remedied 
only  by  in  some  wav  getting  rid  of  putrefactive 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    187 

bacteria  and  putrefaction  processes  that  are  active 
in  the  intestines. 

Dr.  Tissier,  of  the  Pasteur  Institute,  was  the 
first  to  point  the  way  to  methods  of  changing  the 
flora  of  the  intestine.  His  plan  was  to  displace 
"wild,"  noxious,  poison-forming  bacteria  which  have 
taken  possession  of  most  adult  intestines  through 
wrong  habits  of  life,  especially  in  diet,  by  harm- 
less, acid-forming  species,  such  as  Nature  plants 
in  the  intestines  of  the  young  infant  within  a  few 
days  after  birth. 

There  are  various  ways  in  which  the  intestinal 
flora  may  be  changed.     Three  things  are  essential: 

1.  The  diet  must  be  such  as  to  encourage  the 
growth  of  friendly  germs,  the  acid-formers,  and 
discourage  the  growth  of  unfriendly  and  unde- 
sirable ones,  the  poison-formers.  This  requires  a 
fleshless  diet  and  in  some  cases  a  diet  free  from 
animal  protein,  that  is,  a  diet  which  excludes  eggs 
and  milk  as  well  as  meats  of  all  kinds. 

2.  The  bowels  must  be  made  to  move  three 
times  a  day  or  more  frequently  so  as  to  hasten  the 
displacement  of  the  undesirable  bacteria  and  to 
dislodge  them  from  their  hiding  places. 

3.  The  introduction  of  friendly,  acid-forming 
bacteria  in  such  large  numbers  as  to  enable  them 
to  take  possession  of  the  intestine  and  establish 
themselves  in  the  colon  where  their  services  in 
-combating  putrefactive  processes  is  needed. 

The  change  of  diet  may  be  effected  by  adopting 


188  COLON  HYGIENE 

the  "milk  regimen"  for  a  limited  period.  The  "fruit 
regimen" — fresh  fruit  and  such  green  vegetables  as 
lettuce,  celery,  and  cucumbers  answers  the  same 
purpose.  The  "  whey  cure,"  "  kumyss  cure,"  and 
"milk  cure"  are  other  dietetic  methods  of  changing 
the  flora. 

Fasting  will  not  change  the  flora  for  reasons 
given  elsewhere,  (see  pages  103-106). 

In  general,  the  antitoxic  diet  elsewhere  described 
(see  pages  221-240)  is  the  most  practical  solution  of 
the  diet  problem  in  relation  to  bacterial  change  in 
the  intestine.  In  cases  in  which  it  is  desirable  to 
secure  a  gain  in  flesh  in  connection  with  a  change 
of  the  intestinal  flora,  a  milk  diet  may  be  success- 
fully employed. 

The  "Milk  Regimen" 

Cow's  milk  is  not  a  natural  food  for  grown-ups, 
either  human  or  bovine.  Milk  is  deficient  in  iron, 
and  contains  an  excess  of  protein,  and  lime.  Cow's 
milk  disagrees  with  many  persons,  children  as  well 
as  adults.  It  is  certainly  by  no  means  an  ideal 
food.  Yet  many  persons  are  benefited  by  its  tem- 
porary use  when  proper  precautions  are  taken. 
The  first  essential  is  that  the  milk  shall  be  taken 
in  large  amount,  so  large  as  greatly  to  exceed  the 
needs  of  the  body,  and  thus  fill  the  alimentary 
canal  with  material  which  will  promote  the  grov/th 
of  friendly  bacteria,  or  sour  milk  germs,  for  which 
milk  supplies  the  very  best  medium. 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    189 

A  second  essential  is  that  the  milk  shall  be 
taken  often.  A  half  pint  every  half  hour  or  every 
forty  minutes  is  the  usual  plan.  This  is  necessary 
to  make  it  possible  to  take  into  the  stomach  the 
five  or  six  quarts  of  fluid  required  for  one  day's 
milk  ration.  It  is  also  important  to  maintain  a 
constant  stream  of  fresh  material  passing  along  the 
alimentary  canal,  so  that  a  considerable  portion 
may  reach  the  colon  undigested  and  unabsorbed.  It 
is  especially  important  that  a  sufficient  amount 
of  milk  sugar  should  reach  the  colon  unabsorbed 
to  maintain  in  the  colon  a  state  of  acid  fermenta- 
tion thereby  preventing  putrefaction  and  changing 
the  intestinal  flora.  This  is,  indeed,  in  many  cases, 
the  chief  benefit  derived  from  the  milk  diet.  To 
encourage  this  change  it  is  w^ell  to  give  at  each  al- 
ternate feeding  yogurt  buttermilk  in  place  of 
sweet  milk;  or  equal  parts  of  sweet  milk  and  milk 
soured  by  the  Bulgarian  ferment  may  be  taken  at 
each  feeding. 

Feeding  begins  at  7:00  a.  m.  and  ends  at  7:00 
p.  m. — twenty- five  feedings  in  all.  At  10:00  a. 
m.  and  4:00  p.  m.  the  milk  is  omitted  and  a  meal 
of  fruit  is  taken  instead.  The  purpose  of  this  is 
to  encourage  bowel  activity,  since  very  free  and 
frequent  bowel  movement  is  essential  to  success. 
The  disappointing  results  often  encountered  in  the 
use  of  the  milk  diet  are  chiefly  due  to  the  constipa- 
tion which  is  likely  to  be  produced  in  many  persons, 
the  natural  result  of  which   is   intestinal  toxemia 


190  COLON  HYGIENE 

and  an  aggravation  of  the  very  symptoms  relief 
from  which  is  sought. 

An  ounce  of  wheat  bran  or  agar-agar  should  be 
taken  daily  in  half  ounce  doses,  preferably  at  8:00, 
10:00,  12:00,  and  4:00  o'clock  feedings.  In  cases 
in  which  the  colon  is  badly  crippled,  the  use  of 
the  Russian  paraffin  oil  in  doses  of  one  tablespoon- 
ful  three  or  four  times  a  day  is  necessary  to  secure 
the  active  bowels  required  for  a  rapid  and  efficient 
change  of  the  flora. 

When  the  period  of  exclusive  milk  feeding  is 
ended,  the  milk  should  be  at  once  discarded  and  a 
strict  antitoxic  diet  adopted ;  milk,  meat,  fish,  fowl, 
eggs  and  all  kinds  of  animal  protein  must  be  dis- 
carded. Milk  is  unwholesome  for  most  invalids  and 
often  even  in  very  small  amounts.  This  is  especially 
true  of  persons  suffering  from  colitis.  It  is  most 
likely  to  produce  unpleasant  effects  when  taken 
in  small  amounts  with  other  foods.  It  is  generally 
tolerated  when  taken  as  an  exclusive  diet  and  in 
large  amount  because  of  the  special  conditions  estab- 
lished whereby  a  change  of  the  intestinal  flora  is 
accomplished. 

It  should  be  remembered  that  the  chief  advantage 
of  the  milk  diet  as  a  means  of  changing  the  intesti- 
nal flora  lie — (1)  in  the  large  amount  of  milk  sugar 
which  by  this  means  is  carried  into  the  colon  and 
there,  fermenting,  produces  lactic  acid  and  so  pre- 
vents the  growth  of  the  putrefactive  bacteria;  (2) 
in  the  frequent  bowel  actions  induced  by  the  large 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    191 

surplus  of  food  ingested.  The  soft  curds,  undigested 
and  unabsorbed  by  their  bulk  as  well  as  by  their 
acidity  stimulate  peristalsis  to  such  a  degree  as  to 
cause  several  bowel  movements  daily.  In  certain 
cases,  however,  in  which  mechanical  obstacles  to 
bowel  action  exist,  such  as  either  spasm  or  incom- 
petency of  the  ileocecal  valve,  or  adhesions  of  the 
pelvic  colon,  constipation  may  continue  in  spite  of  the 
largest  quantities  of  milk  that  can  be  taken.  In  such 
cases  the  sugar  of  milk  is  wholly  absorbed,  leaving 
the  curds  to  putrefy  in  the  lower  colon,  and  the  most 
intense  toxemia  may  result.  The  writer  has  met  a 
number  of  cases  of  this  sort.  This  is  the  cause  of 
the  disastrous  failure  of  the  "milk  cure"  in  certain 
cases. 

The  "Fruit  Regimen" 

To  meet  the  needs  of  certain  patients  who  have 
an  idiosyncrasy  against  milk,  especially  cases  of 
colitis,  the  writer  has  conducted  a  large  number  of 
experiments  for  the  purpose  of  discovering  a  diet 
for  changing  the  intestinal  flora  suitable  for  general 
use  and  especially  in  cases  in  which  milk  is  not 
tolerated.  The  result  of  many  experiments  was  the 
selection  of  a  diet  consisting  chieily  of  wheat  bran 
and  fruit;  lettuce,  cucumbers,  tomatoes  and  any 
other  uncooked  product  of  the  garden  may  be  added, 
but  the  chief  part  of  the  diet  must  be  bran  and 
fruit.  Such  a  dietary  practically  eliminates  protein 
and  fats.     Food  may  be  taken  either  three  or  four 


192  COLON  HYGIENE 

times  a  day.  Two  or  three  tablespoonfuls  of  ster- 
ilized wheat  bran  should  be  taken  at  each  meal. 
A  convenient  way  to  take  the  bran  is  in  the  form 
of  a  soup  or  porridge  made  with  stewed  toma- 
toes or  some  fruit.  A  spoonful  of  oatmeal  or  corn- 
meal  may  be  added  if  desired. 

All  sorts  of  fruit  may  be  eaten  freely.  Dates  are 
especially  valuable  because  of  the  sugar  which  they 
contain. 

In  addition,  a  paraffin  tablet  or  a  tablespoonful  of 
white  Russian  paraffin  oil  should  be  taken  at  each 
meal. 

The  result  will  be  three  or  four  free  bowel  move- 
ments daily,  and  at  the  end  of  three  or  four  days 
the  stools  will  become  odorless  or  nearly  so.  A  slight 
acidity  is  a  good  indication,  showing  that  the  flora  is 
completely  changed,  the  putrefactive  and  poison- 
forming  germs  having  been  displaced  by  the  benefi- 
cent acid-formers. 

After  the  flora  has  been  thus  changed  by  a  bran 
and  fruit  diet  closely  adhered  to  for  a  few  days^ 
a  careful  antitoxic  diet  should  be  closely  followed  as 
a  permanent  regimen.  It  is  a  great  error  to  suppose 
that  the  intestinal  flora  can  be  definitely  and  perma- 
nently changed  by  a  brief  course  of  treatment  or 
by  any  plan  which  does  not  include  the  complete  and 
permanent  exclusion  of  "toxic"  foods.  Meats  of  all 
sorts  must  be  wholly  discarded.  Eggs  must  be  used 
sparingly  if  at  all.  In  not  a  few  cases  milk  must 
be    carefully    avoided    even    as    an    ingredient    of 


DISCUSSION  OF  ALIMENTARY  TOXEMIA    193 

soups  and  other  dishes.  Some  persons  may  recoil  at 
the  idea  of  so  great  a  limitation  of  the  dietary;  but 
a  person  who  has  suffered  from  such  distressing 
effects  of  chronic  intestinal  toxemia  as  a  severe  ec- 
zema, frequent  "sick  headaches,"  Bright's  disease  or 
arteriosclerosis  will  be  quite  willing  to  undergo  al- 
most any  sort  or  degree  of  gustatory  discipline  if 
assured  that  the  sacrifice  will  secure  the  desired 
result.  Fortunately,  this  assurance  may  usually  be 
given  with  the  greatest  confidence  that  the  results 
will  not  be  disappointing. 

The  free  use  of  bran  and  paraffin  must  be  con- 
tinued indefinitely,  and  care  must  be  taken  not  to 
omit  their  use  at  a  single  meal.  If  thorough  evac- 
uation of  the  bowels  does  not  occur  three  or  four 
times  daily  the  amount  of  paraffin  or  quantity  of 
bran,  or  both,  should  be  increased.  Agar-agar  in 
som^e  form  may  be  used  in  place  of  bran,  or  in  con- 
nection with  it.  There  need  be  no  fear  of  injuring 
the  intestine  by  producing  irritation.  The  v/riter 
does  not  hesitate  to  make  this  statement  after  hav- 
ing carefully  v/atched  the  effects  of  the  measures 
above  recommended  in  hundreds  of  cases.  If  the 
measures  suggested  are  employed  with  sufficient 
thoroughness,  and  continued  for  a  sufficient  length 
of  time,  the  effort  will  not  fail  of  success.  It  is  nec- 
essary in  many  cases,  to  supplement  the  regimen 
recommended  by  means  of  treatment  which  will 
thoroughly  cleanse  the  colon,  introduce  a  normal 
flora,  and  reform  the  wild  bacteria  with  which  the 


194  COLON  HYGIENE 

colon  is  infected.  For  a  detailed  description  of 
these  measures  the  reader  is  referred  to  the  direc- 
tions given  elsewhere  in  this  work  for  the  treatment 
of  colitis.  (See  page  330).  If  an  ammoniacal  or 
putrescent  odor  appears  in  the  feces  at  any  time  the 
fruit  regimen  must  be  resumed  for  a  few  days  un- 
til the  odor  disappears.  The  diet  should  be  care- 
fully studied  and  modified  as  necessary  until  the 
stools  become  regular,  frequent,  and  practically  free 
from  odor,  or  at  least  free  from  putrescence. 


Forms  of  Constipation 
Classification 

Constipation,  although  a  symptom  rather  than 
a  disease,  itself  becomes  a  cause  of  various  and  often 
most  serious  vital  disturbances.  Every  bodily  func- 
tion and  every  structure  may  suffer  damage  through 
the  failure  of  the  body  to  be  relieved  of  the  highly 
poisonous  refuse  which  it  is  the  duty  of  the  colon  to 
discharge. 

The  symptoms  by  which  the  presence  of  consti- 
pation may  be  known  differ  according  to  the  form 
of  constipation  which  is  present.  Although  many 
different  forms  of  constipation  have  been  described, 
practically  all  phases  of  this  disorder  may  be  in- 
cluded under  three  heads,  namely: 

1.  Simple  constipation. 

2.  Cumulative  constipation. 

3.  Latent  constipation. 

The  Symptoms  of  Simple  Constipation 

When  fecal  matters  remain  in  the  intestines 
more  than  twenty-four  hours,  constipation  exists. 
Some  authorities  place  the  limit  at  forty-eight  hours, 
while  others  assert  that  every  individual  is  a  law 
unto  himself,  and  that  a  bowel  movement  once  in 
two  or  three  days  is  as  normal  for  some  persons  as  a 
daily  or  twice-daily  movement  is  for  others.     The 

195 


196  COLON  HYGIENE 

writer  feels  certain  that  these  authorities  are  in  error. 
Their  conclusions  have  been  drawn  from  observa- 
tions made  upon  unhealthy  rather  than  normal 
individuals.  For  reasons  stated  elsewhere  in  this 
work,  the  writer  is  fully  persuaded  that  the  normal 
rhythm  of  the  intestine  is  a  movement  after  each 
meal,  or  at  least  after  each  full  meal.  Certainly, 
when  the  bowels  do  not  move  regularly  at  least 
once  a  day,  constipation  may  be  said  to  exist. 

In  simple  constipation  the  evacuation  of  the 
bowel  content  is  not  complete.  A  normal  desire 
for  evacuation  occurs  when  the  feces  enter  the 
rectum,  but  normal  bowel  movements  occur  only 
every  other  day,  or  perhaps  at  somewhat  longer  in- 
tervals, or  at  irregular  periods.  There  is  simply  a 
slowing  of  the  rate  at  which  the  food  moves  along 
the  alimentary  canal,  due  to  some  one  or  more  of  the 
many  causes  which  have  been  mentioned  in  the  pre- 
ceding pages;  but  there  is  no  disturbance  of  the 
defecating  mechanism. 

Most  cases  of  chronic  constipation  begin  with 
the  simple  form.  The  cause  is  most  commonly  a 
concentrated  diet,  irregular  meals,  sedentary  habits, 
or  neglect  to  attend  promptly  to  the  "call"  for 
evacuation  of  the  bowels. 

Sjnnptonis  of  Cumulative  Constipation 

In  cumulative  constipation,  which  is  perhaps  the 
most  common  form,  the  difficulty  is  almost  wholly 


FORMS  OF  CONSTIPATION  197 

confined  to  the  lower  part  of  the  colon.  Cumu- 
lative constipation  is  for  the  most  part  a  disorder 
of  the  defecating  mechanism.  The  food  and  the 
feces  move  along  the  small  intestine  and  the  upper 
part  of  the  large  intestine  at  the  proper  rate;  but 
after  the  feces  have  reached  the  pelvic  colon,  they 
are  retained  either  in  the  colon  itself  or  in  the  rec- 
tum, instead  of  being  promptly  discharged.  The 
special  characteristics  of  cumulative  constipation  are 
dry  hard  stools,  loss  of  the  rectal  reflex,  caused  by 
the  retention  of  fecal  matters  in  the  rectum  and 
distension  of  the  rectal  walls,  and  in  pronounced 
cases,  complete  loss  of  the  "call"  for  evacuation  of 
the  bowels.  In  cumulative  constipation,  the  diffi- 
culty exists  in  the  lower  half  of  the  colon,  or  be- 
low the  splenic  flexure. 

In  well  pronounced  cases  of  cumulative  consti- 
pation, a  considerable  quantity  of  feces  will  always 
be  found  present  in  the  rectum,  although  in  a  cer- 
tain number  of  cases  the  accumulation  occurs  only 
in  the  pelvic  colon.  The  latter  cases  are  sometimes 
the  most  difficult  of  relief,  ^lecause  of  the  existence 
of  obstruction  at  the  pelvi-rectal  valve,  or  of  ad- 
hesions of  the  pelvic  loop  to  the  floor  of  the  pelvis. 
Sometimes  the  pelvic  colon  has  become  so  large  by 
overstretching  that,  when  filled,  it  is  so  heavj'-  that 
it  cannot  rise,  but  becomes  impacted  in  the  hollow 
of  the  sacrum,  folded  upon  itself  and  incapable  of 
empt}'ing  itself.  In  such  cases,  as  in  most  cases  of 
cumulative    constipation,    bowel    movements    occur 


198  COLON  HYGIENE 

only  as  the  result  of  pressure  from  accumulation 
of  feces  in  the  colon,  a  process  which  necessarily 
involves  great  distension  of  the  colon  and  resulting 
injury  to  its  walls,  and  to  the  ileocecal  valve,  which 
is  often  rendered  by  this  means  wholly  incompetent. 
When  in  cases  of  cumulative  constipation  the 
bowels  are  made  to  move  by  violent  straining  ef- 
forts, the  rectum  is  not  emptied.  A  few  masses  of 
hard,  dry  feces,  sometimes  a  single  mass  covered 
with  mucous,  may  be  extruded,  but  a  thorough 
emptying  of  the  bowel  never  occurs.  In  cases  in 
which  the  rectum  only  has  lost  its  sensibility,  the 
sense  of  weight  and  pressure  often  lead  the  patient 
to  make  repeated  efforts  during  the  day  to  relieve 
the  bowels,  with  the  result  of  securing  perhaps  each 
time  a  small  movement.  This  has  been  termed 
"fragmentary  constipation"  by  Boas,  the  eminent 
Berlin  specialist,  but  it  is  only  a  form  of  cumulative 
constipation. 

Symptoms  of  Latent  Constipation 

In  latent  constipation  the  bowels  move  regularly, 
or  at  least  daily.  In  most  cases  the  patient  has  no 
idea  that  he  is  suffering  from  constipation.  An  ex- 
amination, however,  by  means  of  suitable  tests 
shows  that  there  is  delay  at  one  or  more  points  along 
the  food  tube.  There  is  no  disturbance  of  the 
mechanism  of  defecation.  The  "call"  for  bowel 
movement  occurs,  and  often  with  inconvenient  fre- 


FORIvIS  OF  CONSTIPATION  199 

quency,  and  the  lower  colon  is  emptied  of  its  con- 
tents. There  is  no  accumulation  of  feces  in  the 
rectum,  but  if  a  portion  of  charcoal  or  carmine  is 
given  with  a  meal,  forty-eight  hours  or  even  a  longer 
time  may  elapse  before  the  colored  matter  makes  its 
appearance,  and  a  longer  time  before  it  is  all  dis- 
charged. 

The  exact  point  at  which  the  delay  occurs 
may  be  ascertained  by  administering  a  bismuth 
test  meal  and  watching  its  progress  along  the  food 
tube  by  the  aid  of  a  powerful  X-ray  apparatus.  An 
examination  of  this  sort  is  highly  important  in 
cases  of  latent  constipation,  affording  the  only  means 
by  which  the  real  nature  and  location  of  the  dis- 
turbance can  be  ascertained. 

The  feces  in  latent  constipation  are  generally 
very  dark  in  color,  ragged  and  foul  smelling,  the 
result  of  the  advanced  putrefaction  induced  by  their 
long  retention. 

The  reflex  contraction  of  the  ileocecal  valve  pro- 
duced by  the  pain  of  chronic  appendicitis  and  other 
painful  affections  of  the  pelvis  and  lower  abdomen, 
may  be  the  cause  of  latent  constipation,  which, 
when  due  to  this  cause,  is  sometimes  called  "reflex" 
constipation,  for  the  reason  that  it  is  generally  re- 
lieved by  measures  which  lessen  the  activities  of  the 
sympathetic  nerve  and  so  relax  the  ileocecal  sphinc- 
ter. Latent  constipation  is  also  very  commonly 
associated  with  colitis,  on  account  of  the  spastic  con- 
dition of  the  intestine  often  present  in  this  disease, 


200  COLON  HYGIENE 

which  may  be  a  consequence  as  well  as  a  cause 
of  latent  constipation. 

Incompetency  of  the  ileocecal  valve  is  probably  a 
very  frequent  cause  of  latent  constipation. 

A  marked  symptom  of  latent  constipation  when 
associated  with  incompetency  of  the  ileocecal  valve  is 
the  great  amount  of  intestinal  gas  from  which  it  is 
impossible  to  get  entire  relief.  This  is  due  to  the 
fact  that  the  gas  generated  in  the  colon  escapes  into 
the  small  intestine  and  cannot  be  wholly  expelled 
because  the  colon  discharged  its  contents  internally, 
into  the  small  intestine,  as  well  as  externally. 

Mixed  Forms  of  Constipation 

The  majority  of  cases  of  constipation  may  be 
clearly  assigned  to  one  of  the  above-defined  classes. 
Not  infrequently,  however,  cases  are  encountered 
which  present  most  of  the  symptoms  of  the  several 
classes  of  constipation.  Colitis  with  spastic  con- 
stipation is  often  observed  in  cases  in  which  there  is 
also  a  failure  of  the  defecating  mechanism  to  per- 
form its  work  properly,  and  cumulative  constipation. 


The  Treatment  of  Constipation 

Hygiene 

The  first  point  of  importance  in  the  treatment 
of  constipation  is  h5'-giene.  A  person  must  by  every 
means  in  his  power  endeavor  to  improve  his  general 
health.  Chronic  ill  health  always  involves,  either 
primarily  or  secondarily,  a  lowering  of  the  vital 
status,  and  is  in  most  cases  not  a  result  of  a  single 
error  in  habits  of  life,  but  of  numerous  infractions 
of  the  rules  of  healthy  or  biologic  living.  So  many 
different  factors  are  involved  in  the  function  of 
bowel  movements,  that  it  is  highly  essential  that  a 
person  who  is  suffering  from  chronic  constipation 
should  seek  by  every  available  means  to  improve 
his  general  health,  and  thus  increase  the  vigor  of  all 
his  bodily  functions. 

If  one's  habits  have  been  sedentary,  he  must  make 
a  radical  change  in  his  mode  of  life.  When  possible, 
a  change  from  an  indoor  employment  to  an  active 
occupation  out-of-doors  is  most  desirable.  This  in 
itself  will  in  many  cases  be  found  quite  sufficient 
to  secure  regular  bowel  movements. 

If  the  circumstances  of  life  have  been  such  as  to 
give  rise  to  worry  or  nervous  depression,  some 
change  should  be  effected  by  which  the  causes  of 
irritation  and  depression  may  be  gotten  rid  of,  or 
the  individual  should,  by  the  cultivation  of  optim- 

201 


202  COLON  HYGIENE 

ism,  endeavor  to  rise  above  the  influence  of  his 
surroundings. 

Constipation  is  in  most  cases  simply  one  of  the 
unhappy  results  of  the  artificial  conditions  imposed 
upon  us  by  modern  civilized  life.  The  only  escape 
from  this  terrible  handicap  of  all  useful  human 
activities  is  to  be  found  in  a  rational  return  to 
Nature,  in  the  adoption,  so  far  as  is  necessary  to 
secure  the  physiological  conditions,  of  natural  and 
primitive  habits,  particularly  in  reference  to  diet, 
sleep,  exercise,  and  out-of-door  life. 

Before  proceeding  further  the  reader  who  is 
making  a  serious  study  of  this  subject  is  asked  to 
re-read  carefully  two  of  the  preceding  chapters, 
entitled,  "Influences  Which  Normally  Excite  the 
Movements  of  the  Colon"  and  "Influences  Which 
Discourage  or  Lessen  Intestinal  Movements,"  bear- 
ing always  in  mind  the  fact  that  for  the  successful 
treatment  of  constipation  every  possible  factor  which 
aids  bowel  activity  must  be  utilized,  and  that  every 
factor  which  has  a  discouraging  influence  must 
be  most  carefully  avoided. 

General  Habits 

Many  of  the  causes  of  constipation,  and  many 
of  the  influences  connected  with  every-day  life  which 
tend  to  produce  this  condition,  have  been  already 
discussed  with  some  detail,  and  need  not  be  recon- 
sidered here.     The  bearing  of  each  one  of  these 


TREATMENT  OF  CONSTIPATION  203 

causes  should  be  considered  in  each  individual  case, 
and  not  one  unfavorable  influence  should  be  per- 
mitted to  remain. 

Clothing 

This  has  a  very  much  more  direct  bearing  upon 
the  functions  of  the  colon  than  might  at  first  be 
supposed.  Corsets  and  belts,  as  has  already  betn 
?hown,  tend  directly  to  produce  constipation  by 
hampering  the  movements  of  the  diaphragm,  pre- 
venting proper  development  and  activity  of  the 
abdominal  muscles,  and  causing  displacement  of 
the  colon  and  other  viscera  into  the  lower  portion 
of  the  abdomen.  Excess  of  clothing  tends  in  the 
same  direction  by  overheating  the  body  and  pro- 
ducing excessive  perspiration  and  relaxation  of  the 
muscular  structures  of  the  abdomen,  and  perhaps 
also  of  the  intestines. 

Finally,  as  regards  hygiene,  every  person  vt^ho 
is  suffering  from  constipation  and  really  desires  to 
be  delivered  from  the  miseries  attendant  upon  this 
condition  should  be  careful  to  avoid  all  habits  and 
influences  which  tend  to  retard  or  discourage  bowel 
action  and  will  most  assiduously  cultivate  every 
influence  and  habit  which  tends  to  encourage  in- 
testinal activity. 

Constipation  AWays  Curable 

Every  person  who  undertakes  to  combat  con- 
stipation should  know  at  the  start  that  his  efforts  if 


204  COLON  HYGIENE 

thoroughgoing  and  persistent  may  be  expected  to 
win.  There  are  many  thousands  of  sufEerers  who 
have  become  utterly  discouraged  through  unsuccess- 
ful efforts  and  have  become  convinced  that  the 
malady  is  incurable,  and  that  nothing  more  can 
be  done  than  to  mitigate  the  evils  of  the  malady  as 
much  as  possible  by  laxative  drugs  and  the  use  of  the 
enema,  withstanding  their  well-known  evil  effects. 
There  are  many  thousands  of  others  who  depend 
wholly  upon  the  use  of  laxative  drugs  or  mineral 
waters  for  bowel  movements  and  who  are  unaware 
of  the  harmful  effects  which  inevitably  result  from 
the  long  continued  use  of  drugs  which  force  bov/el 
movement  by  creating  an  artificial  irritation.  The 
majority  of  such  persons  are  always  looking  for 
some  new  laxative  drug  to  take  the  place  of  one 
which  has  lost  its  effects,  fully  believing  that  there 
is  no  other  way  of  doing.  There  is  apparently  a 
widespread  belief  that  constipation  is  incurable. 
This  hopeless  view,  quite  generally  held  by  physi- 
cians as  well  as  the  laity,  is  the  very  natural  result 
of  the  wrong  methods  which  are  generally  employed, 
and  the  great  ignorance  concerning  the  intimate 
nature  and  causes  of  constipation.  This  ignorance 
has  been  quite  excusable,  however,  because  of  the 
lack  of  scientific  knowledge  respecting  the  phj^si- 
ology  of  bowel  action.  But  now  that  the  light  of 
new  discovery  has  illuminated  this  dark  corner  of 
human  physiology,  the  treatment  of  constipation  is 
no    longer    necessarily    a   hopeless    groping    in    the 


TREATMENT   OF   CONSTIPATION  205 

dark  but  may  be  made  a  regular  organized  cam- 
paign against  an  enemy  whose  nature  and  favorite 
haunts  are  known  and  against  which  recent  medical 
science  has  provided  efficient  weapons. 

And  a  veritable  campaign  the  effort  must  be  if 
success  is  to  be  attained  in  really  grave  cases.  But 
victory  may  be  attained  in  every  case.  It  must  be 
understood,  however,  that  there  is  no  panacea  for 
constipation.  There  is  no  one  sinqple  means  by 
which  all  cases  may  be  cured,  and  some  cases  require 
the  simultaneous  employment  of  almost  every  knov/n 
rational  remedy.  A  very  few  cases  require  the 
aid  of  surgery;  and  even  surgery  seldom  succeeds 
when  made  the  sole  reliance.  Fortunately  surgery 
is  very  rarely  needed  when  all  other  means  are  ef- 
ficiently used. 

What  Is  a  Cure  of  Constipation? 

When  a  child  has  measles  or  scarlatina  or  v%^hen 
a  person  suffers  an  attack  of  typhoid  fever,  the 
usual  result  under  modern  management  is  such  a 
recovery  that  no  traces  of  the  disease  or  its  effects 
are  discoverable.  The  individual  is  apparently  as 
well  in  every  respect  as  before  the  illness.  Mod- 
ern medical  research  has  taught  us,  however,  that 
this  completeness  in  recovery  is  more  apparent  than 
real.  Besides  the  permanent  injuries  to  eyes  and 
ears,  which  are  often  left  after  measles  and  scarlet 
fever,  there  are  not  infrequently  far  more  serious 


206  COLON  HYGIENE 

injuries  to  heart,  lungs,  or  kidne3's.  And  statistics 
show  that  whenever  tj'phoid  fever  and  small-pox 
are  prevalent,  pulmonary  tuberculosis  increases. 
Thus  we  know  that  recovery^  does  not  really  mean, 
even  in  acute  disease,  absolutely  complete  restora- 
tion to  former  soundness. 

In  chronic  disease  this  is  still  more  evident.  An 
attack  of  acute  disease  is  like  a  sudden  outburst  of 
flame  in  a  dwelling  from  the  upsetting  of  a  lamp  or 
from  some  similar  accidenL  The  fire  is  usually 
quickly  extinguished  and  the  house  itself  is  little 
injured.  A  chronic  malady  is  often  like  a  fire 
which  has  begun  in  the  basement  of  the  house  and 
has  graduall}''  worked  its  way  up  in  the  inner 
walls  until  it  has  reached  the  top  and  burst  out  in 
flame  through  the  roof.  Acute  disease  we  may 
say  is  analagous  to  a  fire  in  a  house  while  chronic 
disease  is  a  fire  of  a  house.  In  lung  tuberculosis 
a  cure  means  an  arrest  of  the  disease  process  and  a 
healing  of  ulcerated  surfaces  in  the  lung;  but  lung 
tissue  vv'hich  has  been  destroj-ed  is  not  restored ;  and 
the  consumptive  v/ho  has  been  cured  by  the  out- 
of-door  life  and  other  means  must  continue  to  em- 
ploy the  essentials  of  the  curative  treatment  in 
order  to  keep  well.  No  consumptive  can  expect  to 
remain  well  if  he  returns  to  the  old  conditions  of 
life  under  which  he  became  ill.  He  must  make  a 
radical  change  in  his  habits  of  life  and  the  change 
must  be  permanent.  In  case  of  an  injurj'  to  a  leg, 
the  patient  may  recover,  but  with  the  loss  of  a  leg. 


TREATMENT  OF  CONSTIPATION  207 

By  the  aid  of  an  artificial  leg  he  will  be  able  to  walk 
very  well,  but  not  so  well  as  with  a  natural  limb. 

The  situation  is  exactly  the  same  in  constipa- 
tion. In  very  chronic  cases,  much  irreparable  dam- 
age has  been  done.  The  colon  has  been  perma- 
nently crippled.  The  art  of  treatment  is  to  find 
out  the  exact  nature  of  the  injury  and  to  find  means 
for  supplying  the  needed  aid,  much  as  an  artificial 
leg  in  a  large  measure  supplies  the  place  of  a  missing 
limb.  These  measures  must  be  such  as  render 
aid  in  a  physiologic  way,  and  must  be  harmless  in 
character.  When  once  the  necessary  means  have 
been  found  and  adapted  to  the  individual  case  they 
must  be  perseveringly  employed  not  for  a  few 
days  or  Weeks  or  months;  their  use  must  become  a 
life  habit.  In  general  it  is  possible  to  secure  a 
considerable  degree  of  improvement  so  that  a  few 
and  simple  means  will  afford  all  the  aid  required 
though  at  first  the  concerted  use  of  many  measures 
was  required. 

If,  for  example,  it  is  found  that  the  addition  to 
the  food  of  a  liberal  quantity  of  sterilized  wheat 
bran  will  secure  three  normal  bowel  movements 
daily,  this  simple  means  must  be  faithfully  used, 
not  only  daily,  but  at  every  meal.  If  it  is  found 
that  the  bowels  are  ready  for  evacuation  at  a  certain 
hour,  a  natural  "call"  being  experienced  at  that- 
time,  this  hour  must  be  religiously  set  aside  for  this 
duty.  Nothing  may  be  allowed  to  interfere  witli 
this  duty.     Whatever  plan  or  program  is  found  to 


208  COLON  HYGIENE 

secure  efficient  bowel  action,  this  program  must  be 
carried  out  every  day  with  greatest  circumspection. 
Nature  must  not  be  discouraged  or  thwarted  in  her 
efforts.  Every  pains  must  be  taken  to  foster  every 
symptom  of  returning  normality  in  bowel  functions. 
When  a  "call"  occurs,  it  must  be  answered  at  once. 
The  delay  of  a  few  minutes  only  may  extinguish  the 
effort  Nature  is  making  to  reestablish  the  normal 
rhythm.  It  takes  considerable  will  and  character  to 
conquer  constipation  as  well  as  knowledge  and  per- 
severance. But  the  gain  in  clearness  of  mind,  zest 
for  work,  endurance  of  mind  and  body,  and 
general  efficiency,  to  say  nothing  of  such 
gains  as  keenness  of  appetite,  sweetness  of  breath, 
clearness  of  skin,  sound  sleep  and  sense  of  joy  in 
being  alive,  are  ample  compensation  for  the  effort 
required.  If  it  is  a  life-long  battle  to  conquer 
constipation,  it  may  be  a  v/inning  battle  and  one 
which  lengthens  one's  days  and  wonderfully  in- 
creases capacity  for  useful  activity  and  enjoyment 
of  life.  , 

When  Is  Surgery  Needed? 

It  will  not  be  possible  to  review  in  a  brief  para- 
graph the  various  opinions  which  have  been  ex- 
pressed by  eminent  medical  authorities  respecting  the 
indications  for  surgical  relief  in  cases  of  obstinate 
constipation,  nor  to  offer  the  reasons  for  or  against 
the   various   surgical   procedures   which   have   been 


TREATMENT  OF  CONSTIPATION  209 

proposed.  It  must  suffice  simply  to  enumerate  the 
principal  conditions  concerning  which  the  concensus 
of  authoritative  surgical  opinion  is  settled  and 
clearly  defined. 

Constipation  due  to  organic  obstruction  resulting 
from  tuberculosis,  cancer,  or  other  morbid  grov/ths, 
necessarily  requires  surgical  interference,  and  an 
abdominal  surgeon  should  be  consulted  at  once, 
one  experienced  in  intestinal  surgery.  This  is 
important,  for  in  surgery  of  this  character  results 
depend  almost  wholly  upon  exactness  and  perfection 
of  technic,  such  as  can  be  gained  only  by  long  and 
extensive  practice. 

Chronic  as  well  as  acute  appendicitis  is  an  indi- 
cation which  may  open  the  way  for  relief  of  con- 
stipation by  removal  of  an  active  cause.  This  is 
especially  true  in  cases  in  which  an  X-ray  examina- 
tion shows  many  adhesions  about  the  inflamed  ap- 
pendix, which  fix  the  cecum  so  that  it  cannot  empty 
itself  or  perhaps  cause  obstruction  of  the  lower  end 
of  the  small  intestine.  The  necessity  for  opera- 
tion may  exist  in  cases  of  this  sort,  even  when 
little  pain  is  felt  in  the  region  of  the  appendix.  Not 
every  case  in  which  such  adhesions  exist,  however, 
requires  operation.  By  far  the  great  majority  may 
be  substantially  relieved  by  non-surgical  measures. 

Adhesions  of  the  ascending  or  descending  colon, 
and  especially  adhesions  which  compress  the  pelvic 
colon  and  limit  its  movements,  may  be  relieved  by 
appropriate  surgical  procedures  when  other  means 


210  COLON  HYGIENE 

fail.  These  cases  seldom  require  removal  of  the 
colon  or  any  portion  of  it,  or  even  the  so-called 
short-circuiting  operation  v^^hich  often  affords  only 
temporary  relief  unless  care  is  taken  to  restore  the 
ileocecal  check  valve.  When  adhesions  of  the  pelvic 
colon  are  broken  up  the  pelvic  loop  must  be  sus- 
pended in  such  a  way  as  to  prevent  the  reproduc- 
tion of  the  restricting  adhesions  which  will  almost 
certainly  occur  unless  some  efficient  means  of  pre- 
vention is  adopted. 

A  very  definite  indication  for  operation  in  cer- 
tain cases  in  which  other  n  °ans  fail  is  incompetency 
of  the  ileocecal  valve  accompanied  by  very  pro- 
nounced stasis  or  stagnation  in  the  small  intestine. 
This  condition  is  sometimes  accompanied  by  the 
most  incorrigible  constipation  and  by  most  pro- 
nounced intestinal  toxemia  as  shown  by  enormous 
quantities  of  indican  and  other  putrefactive  products 
in  the  urine  and  by  Intractable  headaches.  An 
operation  has  within  a  few  years  been  devised  by 
which  the  Incompetent  valve  may  be  repaired  so 
as  to  effect  a  radical  cure  of  the  incompetency  of 
the  valve  and,  fortunately  without  any  considerable 
degree  of  risk.  This  operation  has  been  now  per- 
formed in  a  sufficient  number  of  cases  to  demon- 
strate Its  value  in  cases  which  do  not  yield  to  other 
measures. 

Diverticulitis  (see  page  348)  sometimes  requires 
operation  but  probably  much  less  often  than  has 
been  thought  If  thorough-going  non-surgical  meas- 


TREATMENT  OF  CONSTIPATION  211 

ures  of  treatment  are  instituted.  Anal  hemorrhoids, 
fissures,  fistula,  spasm  due  to  local  irritation,  recto- 
cele  in  women  and  prolapse  of  the  rectum  are  other 
measures  which  may  be  readily  cured  by  surgical 
procedures  which  are  not  attended  by  risk  nor 
even,  when  skillfully  done,  by  much  pain  or  incon- 
venience. 

Regularity  of  Meals  Necessary 

The  bowels  do  not  move  without  a  reason  for 
moving.  The  pelvic  colon  is  an  ejecting  apparatus 
for  expelling  fecal  residues,  which  works  only  when 
brought  into  action  by  the  reflex  nervous  mechanism 
which  comprises  the  nerves  of  the  rectum,  the  de- 
fecating center,  and  the  connecting  nerve  trunks. 
The  entrance  of  food  into  the  rectum  is  like  the 
closing  of  a  switch  which  controls  the  starting  and 
stopping  of  a  motor.  When  the  rectum  is  distend- 
ed, the  nerves  are  stimulated,  and  in  turn  excite  the 
defecating  center  where  they  originate.  From  this 
center  are  sent  out  impulses  which  cause  the  pelvic 
colon  to  contract  strongly  and  empty  itself.  In 
doing  this  it  is  assisted  by  strong  contractions  of  the 
abdominal  muscles  and  of  the  rest  of  the  colon. 

This  process,  it  must  be  remembered,  is  set  in 
operation  only  when  there  is  a  sufficient  movement 
of  feces  from  the  pelvic  colon,  where  the  feces  are 
stored,  into  the  rectum,  to  produce  the  necessary 
amount  of  stimulation.  As  we  have  already  seen, 
this  is  accomplished,  normally,  by  peristaltic  move- 


212  COLON  HYGIENE 

ments  set  up  by  taking  into  the  stomach  relishable 
food.  In  constipation,  these  stimulating  reflexes 
are  often  weak,  and  must  be  reinforced  by  every 
means  possible.  Hence  the  diet  must  be  so  managed 
as  to  secure  the  maximum  amount  of  stimulating 
influence  upon  the  lower  bowel.  Eternal  vigilance 
is  necessary;  every  meal  must  be  taken  with  refer- 
ence to  the  bowel  action.  A  single  omussion  of  a 
meal,  or  a  meal  of  unsuitable  food,  may  be  sufncient 
to  produce  an  undue  accumulation  of  feces  in  the 
colon  and  rectum,  and  unless  this  is  immediately 
corrected,  the  most  serious  results  may  follow.  The 
taking  of  food,  then,  serves  a  double  purpose,  it 
supplies  the  body  with  needed  nourishment  and  at 
the  same  time  furnishes  the  impulse  needed  to  enable 
the  body  to  get  rid  of  the  unusable  residues  of  a 
previous  meal  and  of  a  portion  of  its  constantly 
accumulating  intestinal  excretions.  So  if  regularity 
of  bowel  movement  is  to  be  expected,  care  to  take 
the  food  at  regular  intervals  becomes  a  matter  of 
absolute  importance.  With  the  savage,  regularity 
of  bowel  movem-ent  is  not  a  matter  of  so  great 
importance,  for  the  reason  that  he  is  rarely  so  situ- 
ated that  he  cannot  respond  quickly  to  the  "call"  for 
evacuation.  But  civilized  human  beings  by  their 
systematic  and,  in  general,  their  closely  occupied 
life,  must  often  find  themselves  in  circumstances 
which  compel  a  considerable  delay  in  answering 
the  "call"  without  being  seriously  incommoded. 
Rather  than  interrupt  the  normal  rhythm,  even  on 


TREATMENT  OF  CONSTIPATION  213 

a  single  occasion,  it  would  be  better  to  incur  a  very 
considerable  degree  of  inconvenience,  a  fact  which 
the  constipated  must  take  to  heart  and  ca.rr/  in 
mind;  but  it  is  better  to  observe  such  an  order  of 
life  and  such  regularity  of  habits  as  will  cause  the 
bowels  to  move  at  a  time  at  which  they  may  without 
haste  or  inconvenience  receive  the  leisurely  and 
thorough  attention  which  the  importance  of  this 
function  demands. 

Every  meal  must  contain  foods  which  will  leave 
a  sufficient  amount  of  residue  to  prevent  stagnation. 
To  neglect  this  fact  on  a  single  occasion  may  in  the 
case  of  a  constipated  person,  v/ho  by  careful  atten- 
tion to  regimen  has  established  regular  bowel  habits, 
cause  the  beginning  of  a  return  of  all  the  old  con- 
ditions. 

Too  much  emphasis  cannot  be  laid  upon  the 
absolute  and  unfailing  faithfulness  required  to  main- 
tain the  improved  condition  which  may  have  been 
attained.  The  majority  of  cases  of  constipation 
relapse  sooner  or  later,  but  chiefly  because  patients 
return  to  their  old  irregular  and  careless  habits. 
Drugs  are  resorted  to  because  by  their  use  the 
difficulty  is  temporarily  overcome  with  so  much  less 
trouble  and  self-control  than  is  needed  for  the  com- 
plete regulation  of  one's  habits  of  life,  especially 
in  relation  to  eating.  Sufficient  care  in  the  matter 
of  diet  vv^ill  be  followed  by  success  in  nearly  all 
cases  of  simple  constipation.  It  is  necessary,  how- 
ever, that  the  proper  regimen  should  be  strictly  and 
uninterruptedly  followed. 


214  COLON  HYGIENE 

Supplementary  Bowel  Movements 

The  act  of  defecation  must  be  made  as  complete 
as  possible.  The  rectum  and  lower  bowel  are  often 
iilled  with  dry  feces  which  are  an  obstacle,  the 
removal  of  which  by  patient  and  continued  effort 
may  be  followed  by  a  full  and  natural  movement. 

Sometimes  a  partial  movement  will  be  followed 
by  another,  within  a  half  hour  or  less.  Many 
persons  evacuate  their  bowels  in  the  morning  by 
two  movements,  one  on  rising  and  the  other  soon 
after  breakfast.  Whatever  may  be  the  vagaries  of 
the  individual  colon,  if  it  can  be  persuaded  to  act 
at  all,  other  things  must  be  accommodated  to  its 
needs.  In  many  cases,  always  when  the  movement 
seems  less  complete  than  usual,  it  is  wise  to  give 
the  bowels  a  second  opportunity  for  movement  a  few 
minutes  or  half  hour  later.  If  a  second  "call"  is 
experienced,  the  matter  should  not  be  ignored,  but 
should  receive  instant  attention.  The  moving  of  the 
bowels  is  a  matter  of  equal  importance  with  the 
taking  of  meals,  and  should  be  given  the  same  con- 
sideration. A  crippled  colon  must  be  humored  and 
coddled,  so  to  speak,  and  in  many  cases  apparently 
hopeless  the  result  may  be  in  time  that  the  colon 
may  be  trained  back  to  habits  of  normal  activity 
and  regularity. 

Sleep 

The  important  relation  of  sleep  to  constipation  is 
shown  by  the  fact  that  loss  of  sleep,  or  a  change  of 


.   TREATMENT  OF  CONSTIPATION  215 

sleeping  hours  from  night  to  day,  very  quickly  upsets 
the  bowel  rhythm  when  it  is  nicely  balanced  in  a 
person  of  sedentary  habits.  Cannon  showed  that 
the  bowel  contents  advance  very  slowly  during 
sleep,  but  very  rapidly  during  and  directly  after 
eating.  Evidently  sleeping  after  eating  must  tend 
to  constipation  by  interfering  with  the  normal  ad- 
vance of  the  colon  contents  toward  the  exit. 

Loss  of  sleep  does  not,  however,  increase  bowel 
activity,  but  rather  has  an  opposite  effect,  doubtless 
because  of  its  general  depressing  effects.  This  is 
shown  in  the  lack  of  appetite  and  in  the  coating  of 
the  tongue  which  result  from  loss  of  sleep.  Relish 
for  food  is  one  of  the  normal  stimuli  of  the  intes- 
tines. 

Posture  During  Sleep 

This  is  by  no  means  a  matter  of  no  importance. 
Gravity  exerts  a  decided  influence  upon  the  con- 
tents of  the  stomach  and  intestines  in  states  of 
disease,  although  the  influence  of  this  force  is  of  little 
moment  in  conditions  of  health.  In  health  the  food 
is  grasped  by  the  digestive  tube  as  soon  as  it  reaches 
the  back  of  the  throat,  and  this  vital  grip  is  main- 
tained until  the  residue  of  the  food  is  cast  out  at 
the  anus. 

In  disease,  the  situation  may  be  greatly  changed. 
The  walls  of  the  stomach,  instead  of  contracting 
upon  the  food  and  kneading  it,  are  relaxed  and  hang 


216  COLON  HYGIENE 

loosely  separated  like  the  sides  of  a  bag.  The 
stomach  no  longer  grips  the  food,  and  so  gravitation 
controls  it  to  a  large  degree.  Under  these  circum- 
stances it  is  best  for  the  patient  to  lie  upon  the 
right  side  in  case  a  meal  has  been  eaten  within  two 
or  three  hours  before  going  to  bed,  or  if  there  is 
evidence  of  the  presence  of  food  or  liquid  in  the 
stomach  on  retiring. 

^Vhen  the  cecum  is  known  to  be  dilated  and  the 
seat  of  stagnation,  it  is  well  to  sleep  upon  the  left 
side,  so  as  to  facilitate  the  movement  of  food  along 
the  relaxed  colon. 

In  cases  in  which  the  abdominal  muscles  are 
much  relaxed  and  the  whole  colon  dilated,  so  that 
intra-abdominal  pressure  is  much  reduced,  it  is  well 
to  lie  upon  the  face,  so  that  the  weight  of  the  body 
may  by  constant  pressure  upon  the  abdominal  con- 
tents aid  the  progress  of  the  feces  along  the  crippled 
colon.  Thin  persons  may  often  adopt  with  advan- 
tage the  practice  of  sleeping  on  the  face  with  a 
pillow  beneath  the  abdomen.  Backache,  and  various 
discomforts  in  the  abdomen,  especially  in  cases  of 
colitis,  may  be  relieved  by  this  simple  procedure. 
Persons  whose  stomach  and  intestines  are  much  re- 
laxed and  sluggish  in  consequence  are  much  bene- 
fited by  lying  upon  the  face  for  half  an  hour  or  an 
hour  after  each  meal.  This  not  only  aids  the  pas- 
sage of  liquids  from  the  stomach,  but  helps  the 
colon,  and  prevents  the  excessive  congestion  of  the 
viscera,  which  naturally  results  from  the  excitement 


TREATMENT  OF  CONSTIPATION  217 

of  digestion  when  the  intra-abdominal  pressure  Is 
very  low.  The  nervousness  from  which  many  dys- 
peptic and  constipated  persons  suffer  after  eating 
may  be  relieved  and  prevented  by  half  an  hour's 
rest  Ijang  upon  the  face  after  meals.  It  should  be 
observed  that  it  is  not  well  to  sleep  at  this  time. 


Diet   in   Constipation 

The  writer  once  asked  a  celebrated  Vienna  pro- 
fessor, "What  do  you  do  for  constipation?"  The 
reply  was,  simply,  "Diet."  "But,  professor,  what 
do  you  do  for  cases  in  which  diet  and  all  other 
means  have  failed?"  The  reply  was  still,  "Diet, 
only  diet." 

Proper  regulation  of  diet  is  certainly  the  most 
important  of  all  measures  to  be  adopted  in  the 
treatment  of  constipation  although  there  are  other 
measures  which  are  too  valuable  to  be  neglected. 
A  practical  cure  may  in  many  cases  be  effected  by 
this  means  alone,  provided,  of  course,  that  proper 
attention  is  given  to  ordinary  bowel  hygiene.  No 
attempt  should  ever  be  made  to  treat  a  case  of  con- 
stipation without  proper  regulation  of  diet.  Such 
a  course,  no  matter  how  gratifying  may  be  the  re- 
sults for  the  time  being,  must  end  in  disaster;  for  a 
physiologic  diet  is  of  all  things  most  essential  as 
the  means  of  securing  normal  activity  of  the  intes- 
tines. 

First  of  all,  the  fact  should  be  recognized  that 
food  is  Nature's  laxative.  Natural  food  taken  in 
the  proper  manner  and  at  proper  intervals  gives  to 
the  alimentary  canal  just  the  kind  and  amount  of 
stimulation  that  is  required  to  maintain  the  normal 
procession  of  nutrient  material  along  the  digestive 
tract,   and   to  effect  the  prompt  discharge  of  un- 

218 


DIET  IN  CONSTIPATION  219 

usable  residues  and  poisonous  wastes  from  the  body. 
As  has  been  pointed  out  in  preceding  chapters,  one 
of  the  effects  of  eating  is  to  set  up  in  the  stomach 
a  series  of  vigorous  peristaltic  movements,  which 
pass  from  the  stomach  along  the  whole  length  of 
the  digestive  tube.  Under  normal  conditions 
these  movements  are  sufficient  to  cause  the  fecal 
remains  of  a  preceding  meal  to  move  down  into 
the  lower  and  discharging  part  of  the  colon,  thus 
setting  up  the  reflex  actions  which  result  in  their 
discharge  from  the  body.  This  statement  is  not 
based  upon  theory  alone,  but  is  founded  upon  care- 
ful observations  by  expert  roentgenologists,  made 
upon  the  stomach  and  intestines  with  the  X-ray 
after  the  administration  of  the  bismuth  meal.  It 
also  agrees  with  the  every-day  experience  of  normal 
persons.  The  natural  time  for  the  bov/els  to  move 
is  soon  after  eating,  and  under  fully  natural  con- 
ditions a  bowel  movement  occurs  after  each  meal, 
at  least,  after  each  principal  meal.  The  writer 
has  met  a  number  of  persons  whose  intestines  were 
so  sensitive  to  the  stimulation  of  food  that  the  tak- 
ing of  food  at  any  time,  even  in  a  small  quantity, 
had  the  effect  to  produce  within  a  few  moments  a 
desire  for  evacuation  of  the  bowels.  Cases  are 
occasionally  met  in  which  the  taking  of  food  pro- 
duced such  strong  stimulation  that  the  patient 
found  it  difficult  to  finish  a  meal  without  interrup- 
tion by  the  demand  of  the  bowels  for  evacuation. 
In    the    dietetic    treatment    of    constipation,    it 


220  COLON  HYGIENE 

is  necessary  to  understand  the  particular  properties 
of  food  stuffs  to  which  stimulation  of  the  intestinal 
movements  is  due,  and  to  make  use  of  these  several 
qualities  as  they  may  be  required  in  individual 
cases. 

The  Laxative  Properties  of  Foods 

The  properties  of  food  stuffs  to  which  a  laxative 
influence  is  due  maj^  be  briefly  enumerated  as  fol- 
lows: 

1.  Sapid  qualities  to  which  flavor  or  tastes  are 
due. 

2.  Bulk,  or  rather  the  presence  of  cellulose, 
which  is  capable  of  forming  an  indigestible  residue. 

3.  Moisture,  that  is,  a  necessary  amount  of 
liquid  taken  at  meals  or  between  meals,  especially 
in  connection  with  cellulose  which  by  absorbing 
water  holds  it  in  the  intestine. 

4.  Chemical  properties  which  result  from  the 
presence  of  sugars  and  organic  acids  in  the  food, 
including  the  sugars  formed  by  the  digestion  of 
starch,  and  the  lactic  acids  formed  by  the  fermen- 
tation of  sugar  in  the  intestine.  Fats  are  also 
somewhat  laxative. 

In  the  regulation  of  the  diet  for  the  relief  of 
constipation,  the  aim  must  be  to  make  such  selec- 
tion of  food  stuffs  as  will  furnish  these  various 
laxative  properties  in  the  measure  required  by  the 
individual  case.  This  is  by  no  means  a  simple 
matter,  and  requires,  first  a  very  thorough  knovv"- 


DIET  IN  CONSTIPATION  221 

ledge  of  food  values  and  second,  a  most  thorough- 
going investigation  of  each  individual  case,  so  that 
not  only  the  particular  form  of  constipation  from 
which  he  is  suffering  may  be  known,  whether  it 
is  simple,  cumulative,  or  latent  constipation,  but 
also  at  what  point  or  points  in  the  intestinal  track 
the  delay  occurs,  and  the  cause  of  the  delay.  The 
force  of  this  statement  will  be  fully  appreciated  if 
the  chapter  on  "Causes  of  Constipation"  has  been 
read  with  care. 

Atoxic  and  Antitoxic  Properties  of  Foods 

In  addition  to  the  laxative  properties  of  food 
stuffs,  there  is  another  quality  of  equal  importance, 
which  must  be  duly  considered  in  the  treatment 
of  constipation,  because  of  the  prolonged  stay  of 
undigested  food  remnants  in  the  alimentray  canal 
in  constipation,  and  of  the  tendency  to  delay  which 
will  always  remain,  even  under  the  best  conditions 
which  can  be  supplied.  It  is  of  the  highest  impor- 
tance that  the  food  should  be  of  such  a  character 
as  to  prevent  as  far  as  possible  the  putrefactive 
changes  which  are  always  increased,  and  often  to 
an  extraordinary  degree,  whenever  there  is  delay. 

Of  the  three  essential  food  elements,  carbo- 
hydrates (starch,  sugars  and  organic  acids),  fats, 
and  proteins,  the  last  named  only  is  capable  of  under- 
going putrefaction.  Foods  rich  in  starch  and  su- 
gar do  not  undergo  putrefaction,  either  outside  the 


222  COLON  HYGIENE 

body  or  within  the  intestine,  and  hence,  are  proper- 
ly termed  atoxic  foods. 

Fats  in  excess  encourage  putrefaction,  while 
starch  and  sugar  in  excess  produce  the  opposite  ef- 
fect. By  the  fermentation  of  starch  and  sugar  in 
the  intestine,  acids  are  formed,  which,  as  has  al- 
ready been  pointed  out,  by  interfering  with  the 
growth  of  putrefactive  bacteria,  prevent  putrefac- 
tion. Fats  ferment,  when  taken  to  excess,  form- 
ing butyric  acid,  an  irritant  poison. 

Fruits,  starch  in  vegetables  like  the  potato,  and 
green  vegetables  of  all  sorts,  which  contain  little 
or  almost  no  protein,  together  with  certain  sugars, 
especially  milk  sugar,  maltose  or  malt  sugar,  and 
the  sugar  of  fruits,  and  to  a  less  degree,  cereals, 
particularly  rice,  which  are  very  rich  in  starch,  are 
not  only  atoxic,  being  incapable  of  putrefactive 
changes,  but  are  also  highly  antitoxic,  since  they 
in  a  high  degree  promote  the  formation  of  acids 
in  the  intestine. 

Antitoxic  Value  of  Uncooked  Foods 

A  most  important  point  in  connection  with  this 
subject,  which  appears  to  have  been  overlooked  by 
writers  on  dietetics,  is  the  antitoxic  value  of  un- 
cooked foods.  Man  is  the  only  "cooking  animal." 
To  the  primitive  man  cookery  was  not  only  un- 
known, but  was  as  unnecessary  as  for  any  other 
member  of  the  animal  kingdom.     The  only  really 


DIET  IN  CONSTIPATION  223 

valuable  purpose  served  by  cookery  is  to  enable  man 
to  make  use  of  dried  grains  and  certain  coarse 
vegetables,  which  would  otherwise  be  unavailable 
as  food.  Experience  has  proved  that  food  is  often 
by  cookery  deprived  of  certain  elements  which  are 
essential  to  human  nutrition.  The  argument  made 
by  certain  faddists  who  advocate  the  exclusive  use 
of  a  raw  diet,  that  by  cookery  the  life  principle  is 
driven  out  of  the  food  so  that  its  nutritional  value 
is  lost,  has  no  scientific  basis;  nevertheless,  it  is 
true  that  cookery  destroys  the  life  of  the  cells  of 
vegetable  foods,  and  in  so  doing,  deprives  the  food 
of  certain  properties  which  are  useful  in  the  in- 
testine. Living  cells  resist  the  attacks  of  the  mic- 
robes which  produce  fermentation  and  putrefaction. 
A  raw  apple  or  potato  remains  intact  for  months, 
while  a  cooked  apple  or  potato  is  in  a  few  days 
covered  with  mould,  and  is  in  an  active  state  of 
fermentation  and  destructive  change.  Under 
favorable  circumstances  such  changes  may  take 
place  within  a  few  hours,  as  is  seen  in  the  mould- 
ing of  bread  over  night  if  kept  in  a  warm  place. 
In  other  words,  raw  food  resists  the  destructive 
changes  which  are  produced  by  bacteria,  while 
cooked  food  makes  no  such  resistance. 

An  experiment  made  by  the  writer  some  years 
ago  gave  very  positive  evidence  of  this  fact.  Two 
equal  portions  of  cabbage  were  taken.  One  por- 
tion was  cooked.  Both  portions  were  then  inocu- 
lated with  equal  quantities  of  putrefactive  bacteria, 


224  COLON  HYGIENE 

by  mixing  with  each  a  portion  of  fecal  matter.  The 
two  portions  of  cabbage  were  then  placed  for 
twenty-four  hours  in  an  incubator  in  which  the 
temperature  of  the  body  was  maintained.  Exam- 
ination showed  that  the  bacteria  in  the  cooked  cab- 
bage had  increased  enormously  in  numbers,  where- 
as in  the  uncooked  cabbage  the  number  of  bacteria 
had  not  increased,  but  had  actually  diminished. 

Many  persons  have  thought  themselves  benefit- 
ed by  the  use  of  raw  grains,  such  as  wheat  and  oat- 
meal. While  it  would  be  impossible  for  a  person 
to  live  on  a  diet  consisting  exclusively  of  raw 
grains,  it  is  possible  that  some  benefit  may  be  de- 
rived from  the  use  of  such  food  to  a  moderate  ex- 
tent, through  the  fact  that  uncooked  starch  digests 
slowly.  Cooked  starch,  as  well  as  sugar  and  other 
carbohydrates,  is  normally  wholly  absorbed  in  the 
small  intestine,  or  practically  so,  and  therefore 
furnishes  no  resistance  to  the  growth  of  bacteria; 
but  raw  starch,  if  taken  in  more  than  minute  quan- 
tities, as  has  been  shown  by  experiment  by  the 
writer,  finds  its  way  in  considerable  quantities  into 
the  colon.  Here,  digestion  slowly  proceeds,  pro- 
ducing dextrin  and  sugar,  which  furnish  to  the 
acid-forming  bacteria  just  what  they  require  for 
their  growth  in  a  section  of  the  intestine  where 
the  help  of  these  friendly  organisms  is  most  needed. 
Man's  natural  dietary  comprises  food  containing 
a  sufficient  amount  of  raw  starch  to  prevent  ex- 
tensive putrefaction  in  the  colon;    and    therefore 


DIET  IN  CONSTIPATION  225 

the  art  of  cookery,  while  essential  under  the  con- 
ditions of  modern  civilization,  is  not  altogether  free 
from  disadvantages,  which,  however,  may  easily 
be  obviated  by  a  proper  selection  of  foods  or,  in 
special  cases,  by  including  in  the  ordinary  bill  of 
fare  partially  cooked  foods  containing  a  certain 
portion  of  uncooked  starch,  such  as  oatmeal  or 
other  grains  cooked  six  to  ten  minutes. 

Fruits  are  the  most  highly  antitoxic  of  all  food 
stuffs.  They  possess  in  a  high  degree  all  the  anti- 
toxic properties  of  food, 

1.  They  are  most  acceptable  in  an  uncooked 
state,  both  to  the  palate  and  to  the  digestive  organs, 
They  are  completely  prepared  for  human  sus- 
tenance in  the  great  laboratory  of  Nature,  "cooked 
in  the  sun,"  as  they  say  in  Mexico.  "Cocido  en  el 
sol?"  asked  a  native  fruit  seller  of  the  writer,  who 
was  seeking  to  purchase  some  tropical  fruit  in  the 
market  place  of  a  town  in  Old  Mexico. 

2.  With  very  rare  exceptions,  fruits  contain  a 
considerable  amount  of  organic  acids — citric,  malic 
or  tartaric, — all  of  which  possess  antitoxic  proper- 
ties. Even  many  sweet  fruits  contain  a  considerable 
amount  of  these  acids,  which  are  disguised  by  the 
sugar,  but  which  are  not  neutralized  or  destroyed 
by  it. 

3.  The  sugars  of  fruits  promote  to  a  high  de- 
gree the  growth  of  acid-forming  bacteria  in  the 
intestine,  and  thus  lead  to  the  formation  of  lactic 
acid,  which,  like  the  acids  of  fruits,  is  antitoxic. 


226  COLON  HYGIENE 

The  antitoxic  properties  of  fruits,  though  not 
understood  until  revealed  by  bacteriological  re- 
searches of  recent  years,  have  long  been  utilized 
in  a  practical  w^ay  in  v^hat  is  knov^^n  as  the  "fruit 
cure,"  the  value  of  which  in  the  treatment  of 
chronic  bov^^el  disorders  has  been  well  understood 
for  centuries.  The  grape  cure  of  Switzerland  and 
certain  parts  of  Germany,  the  cherry  cure  advo- 
cated by  Linnaeus,  the  great  botanist,  and  similar 
"cures"  through  the  use  of  apples,  peaches,  and 
other  fruits,  practised  in  several  countries,  owe 
their  value  to  the  antitoxic  properties  of  these 
choicest  of  Nature's  products. 

The  Antitoxic  Laxative   Diet 

Every  constipated  person,  then,  requires  a  bill 
of  fare  consisting  of  antitoxic  and  laxative  foods. 
It  is  most  essential  that  his  diet  should  eliminate 
flesh  foods  of  all  sorts,  including  fish,  oysters,  fowl, 
as  well  as  beefsteaks,  chops,  and  other  red  meats. 
In  many  cases  it  is  also  wise  to  avoid  eggs,  or  at 
least  to  use  them  very  sparingly.  Many  persons 
find  themselves  able  to  digest  the  yolks  of  eggs,  who 
cannot  take  the  whites  either  cooked  or  raw  with- 
out suffering  inconvenience,  because  of  the  readiness 
with  which  this  form  of  albumin  undergoes  putre- 
faction in  the  intestine.  When  eggs  are  freely 
eaten,  especially  if  hard  boiled  or  poached,  or  In 
the   form   of   an   omelette,   portions   of   undigested 


DIET  IN  CONSTIPATION  227 

albumin  may  always  be  found  in  the  stools,  and  in 
a  state  of  very  advanced  putrefaction.  The  gas 
formed  in  the  colon  when  eggs  are  freely  used 
consists  largely  of  sulphuretted  hydrogen,  which 
is  toxic  as  well  as  offensive,  and  affords  most  sub- 
stantial evidence  of  the  luxuriant  growth  of  putre- 
factive bacteria  in  the  colon. 

Those  who  have  been  accustomed  to  the  free 
use  of  meat  and  eggs  are  sometimes  afraid  to  dis- 
pense with  them  lest  they  should  suffer  from  an 
insufficient  supply  of  protein;  but  the  experiments 
of  Chittenden  and  the  extensive  practical  experience 
of  the  Battle  Creek  Sanitarium  have  shown  most 
conclusively  that  the  amount  of  protein  required 
by  the  body  is  so  small  that  it  may  readily  be 
furnished  by  food  derived  exclusively  from  the 
vegetable  kingdom.  In  other  words,  eggs,  and 
meat,  and  even  cow's  milk,  are  quite  superfluous 
as  food,  when  a  good  variety  of  fruit,  cereals  and 
fresh  vegetables  are  available.  If,  however,  an 
additional  supply  of  protein  is  required,  it  may 
readily  be  obtained  from  nuts.  Peanuts,  pine  nuts, 
English  walnuts  and  almonds  are  all  rich  in  pro- 
tein; a  pound  of  pine  nuts,  in  fact,  contains  fifty 
per  cent,  more  protein  than  a  pound  of  lean  beef, 
and  besides,  contains  twice  as  much  more  nutrient 
in  the  form  of  a  most  easily  digestible  fat.  Prac- 
tically the  same  thing  may  be  said  of  almonds  and 
peanuts.  Any  possible  deficiency  in  protein  may 
readily  be  made  up  by  taking  at  meals  a  handful 


228  COLON  HYGIENE 

of  any  kind  of  nut  meats.  It  is  only  necessary  ta 
take  care  to  masticate  them  thoroughly,  so  that 
the  protein  present  may  easily  be  accessible  to  the 
digestive  juices.  A  somewhat  extensive  study  of 
the  laxative  and  antitoxic  properties  of  various 
foods  will  be  found  of  practical  value. 

Cellulose-Containing   Foods 

All  vegetable  foods  contain  more  or  less  cellu- 
lose, but  the  amount  differs  very  greatly.  This 
element,  as  has  already  been  mentioned,  is  highly 
necessary  as  a  means  of  securing  normal  bowel  ac- 
tion. Indeed,  bulk,  not  simply  in  the  food  itself, 
but  in  the  residues  left  behind  after  the  absorption 
of  the  nutritive  portions  of  the  food,  is  of  first 
importance.  This  quality  in  food  is  even  more 
important  than  the  antiseptic  properties,  for  the 
reason  that  putrefactive  bacteria  may  always  find 
in  the  bile  and  other  intestinal  secretions  abundant 
material  to  support  their  growth,  provided  sufficient 
delay  occurs  to  encourage  putrefactive  changes. 
The  thing  most  necessary  in  the  prevention  of 
putrefaction  is  rapidity  of  movement  of  food  resi- 
dues and  body  wastes  along  the  intestine  to  the 
exit. 

.  The  following  tables  shov/  the  amount  and 
percentage  of  cellulose  found  in  the  dried  sub- 
stance of  various  food  stuifs: 


VEGETABLES 

FRUIT6 

Grams 

p«r  ounce 

F»r  ourcf 

Dried  he&ns 

,40.      1           1 

Huckleberries  61.5  1                  1 

Dried  Peas 

28.5   1        1 

Red  Raspberries  37.      |              | 

Len4il5 

20.      1      1 

Blaclcternes      25.      |          | 

Green  Peas 

9.35  0 

Crd^r,  berries      25.                   | 

CftbLaqe 

9.2     D 

Currdni^           23.       |         | 

Parsnip 

8.65  D 

Fi^s             22.5  1      1 

Brussels  3prou{j 

i     7.85  0 

Gooskerries     i7.5   \ | 

Kohlrftbi 

7.75  U 

Pears               15.      D 

Celery 

7.      □ 

Apr\coh        12.5  n 

Turnip 

6.6    D 

Prunes             10.       □ 

Pumpkin 

6,1    D 

Cberr,e.s         10.      [] 

B.PoU^o 

5.45  D 

5irdw-Lcrr.e5  10.      Q 

Beeis 

5.25  D 

Oranses            10      Q 

Asparaqus 

5.2    D 

Plun,3                 7.5   D 

Carrots 

4.9    D 

Grapes               7.5   LI 

iSpinach 

4.65  1 

Rais'ins              7.5   U 

CAuliTlower 

4.55  fl 

5-fewed  Rftisins  7.4  Q 

TomA{oe.s 

4.26  D 

Peevcbes             5.      □ 

Green  Peas 

4.      I 

Apples            5.     G 

Cucumber 

3.9    1 

BAnanas              .3    | 

LeHuce 

3.65  I 

Onion 

3.55  i 

Chart  Showing  Proportion  of  Cellulose  in  Some  of  the  Common 
Vegetables  and  Fruits — Also  Grains  of  Cellulose  per  Ounce 


CEREAL5 


pcrounc* 

Bran      200 


OA<meal  44.  I 

Barleijf^  20.  □ 

Ri;e  15.  D 

Wheai  10.  D 

Corn  Meal  -jrt  j    I 


Corn  FUkM 

CrAh«niF 
CrAnolft 


Crah^mFlour    1f%        j     I 


Rolled 
Whe*t 

9.   D 

Crah^ni 
Bre&d 

6    D 

Wheal  Cr.is 
WhoUW.Brwd 

1.  i 

Unpolished 
Rice 

.751 

Polished 
Rice 

.4  1 

Fine 
Flour 

.3  1 

DIET>S 


Norm*!  Dief-  Fruil. 
Green  V<><)oiable:S.£' 
Gr«h«m  BreAd 

OAlmeAl 
CrAckedWhpdi 


Ordmari/  Mixed        | J 


White  Bre»d 
And  Milk 


Meat 


D 


Chart  Showing  Proportion  of  Cellulose  in  Some  of  the  Common 
Cereal    Foods — Also   Grains   of    Cellulose    per    Ounce. 


DIET  IN  CONSTIPATION  229 
CEEEALS 

PkO     ^Obio     !J§  OO.S  og§S 

Wheat   (cooked)    2        10        26.3  38  30 

Wheat  Grits  (cooked)    .   1           5         18.4  27  60 

EoUed  Wheat   (cracked)  2           9         26.3  36  30 

Graham  Flour    2         10       104  9.6  30 

JPine  Flour    3        1.5    101  1.4  200 

Oatmeal  (cooked)    10         44         18  37  6 

Barley   (cooked)    4         20         31.08    64  15 

Polished  Rice 4        2       101.8  1.96 150 

Unpolished  Eice 75      3.75 101.8  3.68    82 

Eye   (small)    3         15       104  14.4  20 

Corn  Meal 2    10   103  9.7  30 

Corn  Flakes  2    10   103  9.7  30 

Beans  (dried)  8    40   100  40  75 

Peas  (dried)  5.7   28.5  100  28.5  10 

Lentils   4         20       101.8  19.6  15 

Granola   (cooked)    2         10       101.7  9.8  30 

SteriUzed  Bran    40       200        1.5 

Graham    Bread    1.2        6         76  8  50 

Whole  Wheat  Bread    . .   1           5         71.7  7  60 

VEGETABLES 

"w            •       a  .S.2  S  >  m 

<U   O   _   5         0)   ^  m   0-2  m   r.   ca   o 


wm.tHr"         WJO         ^tfl'-'  •'-'03 

^®»>3     -Sifi      "O-S      S°gl 


Asparagus 5.2      13.9      37.4      57.7 


lO 


Beans    4  30.96    12.9 

Beets 5.25  11.6      45  57 

Brussels  Sprouts 7.85      6       131  40 

Cabbage    9.2        8.8    145  32.4 

Carrot    (raw)     4.9  14         36  60 


230  COLON  HYGIENE 

Cauliflower    (steamed)     4.55  10.2  44.6  66 

Celery    (raw)    7  5.5  127  45 

Cucumber    (raw)     3.9  5  78  75 

Green    Peas    9.35  34.4  27  32.2 

Kohlrabi    (raw)     7.75  9  86  39 

Lettuce    3.65  5.6  65  82 

Onion   3.55  10.52  33.7  85 

Parsnips    8.65  17.1  50  36 

Peas    (dried)    28.5  103  27  10.8 

Potato  (baked)    5.45  32.7  16.6  55 

Pumpkin    6.1  9.3  65.6  50 

Spinach    4.65  9.3  50  65 

Tomatoes 4.20  6.Q  63.6  71 

Turnip 6.6  6.1  108  46 

PKUITS 


a  g 

hS 

V   (U 

Prunes   (cooked)    2 

Apples 1 

Pears    3 

Peaches    1 

Plums 1.5 

Cherries 2 

Raspberries,   red    7.4 

Blackberries    5 

Huckleberries 12.2 

Strawberries 2 

Currants    4.6 

Grapes    1.5 

Eaisins 1.7 

Eaisins    (stewed)    ....  1.7 

Oranges    2 

Bananas  3 

Figs    4.5 

Apricots 2.5 

Gooseberries    (stewed)  3.5 

Cranberries 5.0 


o  .,  ^  <u 
.    <u  C  o 

10 

5 
15 

5 

7.5 

10 

37 

25 

61 

10 

23 
7.5 
7.5 
7.4 

10 
1.5 

22.5 

12.5 

17.5 

25 


so 

OS 


27.5 
101 
18.5 
12.8 
24.7 
22.8 
18.3 
16.8 
21.5 
11.4 
16.7 
20.3 
100.3 
100.6 
14.9 
28.9 
92.4 
16.3 
19.4 
48 


2sS 


o  >  m 


&6s  I  ill 


36 
5 

81 

40 

30 

44 
200 
150 
300 

87 
138 

36 

38.4 

67 

5.2 
24.3 
74 
90 
51 


3  U^^ 


30 
60 
20 
60 
40 
SO 
81 
12 
5 
30 
17 
40 
30 
40 
30 
200 
13.3 
24 
17 
12 


DIET  IN  CONSTIPATION  231 

Sterilized  Wheat  Bran 

One  of  the  oldest  and  certainly  the  most  valu- 
able remedy  in  the  treatment  of  constipation  is  ordi- 
nary wheat-bran.  Bran  consists  almost  entirely  or 
very  largely  of  cellulose  in  an  indigestible  form. 
While  wheatmeal  contains  2.5%  of  cellulose,  bran 
contains  18%,  and  in  some  cases  even  more.  In 
the  form  of  bran,  cellulose  is  well  broken  up,  and 
hence  can  be  passed  through  the  intestine  without 
difficulty.  The  apprehension  which  some  authors 
have  expressed  concerning  the  irritating  effects  of 
bran  are  wholly  without  basis,  except,  of  course,  that 
one  would  not  think  of  using  bran  in  a  case  of 
gastric  ulcer  or  acute  inflammation  of  the  stomach 
or  intestines:  As  a  matter  of  fact,  when  well  soft- 
ened with  water,  bran  is  no  longer  irritating,  but 
is  an  emollient.  The  thin  films  of  cellulose  become 
as  soft  and  pliable  as  wet  paper,  and  excite  the 
bowel,  not  by  scratching  or  irritating  it,  but  by  a 
gentle  titillation,  so  to  speak,  and  by  giving  to  the 
food  sufficient  mass  to  distend  the  intestine  and 
stimulate  it  to  vigorous  activity. 

In  its  ordinary  commercial  form,  bran  is  scarce- 
ly fit  for  use,  on  account  of  the  large  amount  of 
dirt  which  it  contains,  including  multitudes  of 
bacteria.  For  intestinal  use  as  a  laxative,  it  should 
be  carefully  prepared  by  thorough  cleaning  and 
washing  of  the  wheat  before  grinding  and  steriliza- 
tion of  the  bran.     Sterilized  bran,  first  introduced 


232  COLON  HYGIENE 

by  the  writer  several  years  ago,  is  now  prepared  by 
various  manufacturers,  and  is  put  up  in  convenient 
packages.  One  or  two  rounded  tablespoonfuls 
should  be  taken  at  each  meal,  the  amount  depend- 
ing upon  the  character  of  other  foods  taken.  The 
writer  has  never  seen  any  ill  effects  from  the  use  of 
sterilized  bran  which  he  has  prescribed  for  many 
years,  although  there  are  cases  in  which  it  fails  to 
produce  the  desired  effect  and  has  to  be  supple- 
mented by  the  use  of  paraffin  oil  as  a  lubricant. 

This  is  particularly  true  in  cases  in  which  the 
cecum  is  greatly  dilated  or  crippled  by  adhesions  and 
in  cases  in  which  there  is  obstruction  of  other  parts 
of  the  colon,  especially  the  pelvic  colon  as  the  result 
of  adhesions. 

The  combination  of  paraffin  oil  with  bran  or 
agar-agar  in  some  form  is  also  useful  in  cases  of 
spastic  contraction  due  to  colitis. 

Experience  shows  that  from  an  ounce  to  two 
ounces  of  cellulose  must  be  taken  with  the  food 
daily,  to  insure  sufficient  bulk  to  stimulate  the 
intestine  to  action.  In  cases  in  which  the  colon 
is  very  redundant  or  is  crippled  by  adhesions,  even 
double  this  amount  may  sometimes  be  needed,  at 
least  until  the  bowel  has  been  trained  to  normal 
action.  This  amount  of  cellulose  is  provided  by 
two  rounded  tablespoonfuls  of  sterilized  bran  in 
addition  to  other  laxative  foods. 

The  amount  of  food  required  to  furnish  an  ounce 
of  cellulose  may  be  ascertained  by  reference  to  the 
foregoing  tables. 


1 

■ 

1 

■HH^I^'?|flp 

H 

HP 

H 

HF'-.  '*  ""         MkSm 

1 

h| 

H 

k^^^jy|y« 

1 

1 

mm 

1 

i 

fl 

11 

^BHfifl^E^ 

i 

i 

i 

Crude   Agar-Agar 


Agar-Agar    in    Sterilized    and    Edible    Form 


DIET  IN  CONSTIPATION  233 

It  should  further  be  mentioned  that  in  the  use 
of  cellulose  in  concentrated  form  as  in  sterilized 
bran,  the  whole  amount  used  at  a  meal  should  not 
be  taken  at  once,  as  at  the  beginning  or  end  of  the 
meal,  but  should  be  well  mixed  with  the  food  by 
taking  small  portions  at  frequent  intervals  during 
the  meal. 

Agar-Agar 

The  use  of  agar-agar,  a  Japanese  sea-weed  of 
a  nature  similar  to  Iceland  moss,  is  to  be  most 
highly  recommended  as  a  means  of  giving  the  neces- 
sary bulk  to  stimulate  the  intestine  to  prompt  ac- 
tion. 

It  may  be  used  without  any  possible  injury  in 
all  cases  of  sluggish  bowel  action.  When  properly 
prepared  it  is  wholly  free  from  unpleasant  flavor, 
and  it  manifests  such  astonishing  avidity  for  water 
that  when  it  is  present  in  the  feces  they  cannot  pos- 
sibly become  dry  and  hard. 

In  cases  in  which  constipation  Is  due  to  "greedy 
colon,"  agar-agar  or  bran  is  indispensable.  In  such 
cases  the  colon  has  acquired  the  power  to  eat  up 
enormous  quantities  of  the  cellulose  of  the  food,  so 
that  it  is  very  difficult  to  increase  the  bulk  of  the 
feces  by  the  use  of  green  vegetables.  This  is  the 
reason  for  the  disappointment  experienced  by  many 
who  hope  to  find  in  the  free  use  of  lettuce  and  like 
green  foods  a  panacea  for  their  intestinal  ills. 
Agar-agar  is  hemi-cellulose,  and  has  been  shown  by 


234  COLON  HYGIENE 

the  experiments  of  Mendel  and  others  to  be  Indi- 
gestible by  any  of  the  digestive  fluids  with  which 
it  comes  in  contact  in  the  human  body.  Agar-agar 
must  be  taken  in  sufficient  quantity  to  accomplish 
the  object  sought.  Two-thirds  of  an  ounce  to  an 
ounce  is  the  quantity  usually  required  for  adults. 
For  young  children  a  quarter  to  a  half  of  this 
quantity  is  sufficient. 

Agar-agar  is  easily  taken  in  soup,  cereal  coffee, 
fruit  juice  or  stewed  fruit.  It  should  be  allowed 
to  soften  and  should  then  be  swallowed  without 
chewing. 

This  remedy  should  be  taken  at  meals  in  order 
that  it  may  be  well  intermingled  with  the  food,  and 
so  prevent  the  formation  of  hardened  residues  in 
the  intestine. 

Agar-agar  may  be  used  with  advantage  as  a 
substitute  for  a  meal,  when  food  cannot  be  taken, 
and  when  there  is  no  appetite  for  food,  and  when 
so  used  it  maintains  the  intestinal  rhythm  which 
would  otherwise  be  lost,  resulting  in  constipation. 
It  should  in  such  cases  be  taken  with  fruit  juice  or 
fresh  or  stewed  fruit.  When  one  finds  at  night 
that  the  usual  amount  of  food  has  not  been  taken, 
an  extra  dose  of  agar-agar  with  a  little  fruit  may 
be  taken  before  going  to  bed.  No  digestive  work 
is  required  by  either  the  fruit  or  the  agar-agar  ex- 
cept to  move  it  along  the  digestive  canal.  It  is 
important  to  take  fruit  or  fruit  juice  with  the 
agar-agar  to  excite  the  necessary  peristalsis. 


DIET  IN  CONSTIPATION  235 

Number  and  Size  of  Meals 

In  very  many  cases  of  chronic  constipation  the 
colon,  especially  the  cecum,  has  become  so  dilated 
that  it  is  seriously  crippled.  Its  thin,  atrophied 
walls  are  unable  to  handle  large  masses  of  materiaL 
In  such  cases,  large  bulky  meals  are  likely  to  over- 
weight the  cecum  and  to  form  an  impaction  which 
may  remain  for  days,  giving  rise  to  fermentation, 
distention  of  the  colon  with  gas,  colic  pains,  and 
great  inconvenience.  Complaint  is  often  made 
that  bulky  foods  cause  much  flatulence  and  distress 
and  seem  to  increase  the  constipation.  The  remedy 
is  not  to  be  found  in  discarding  "coarse  vegetables" 
or  other  bulky  foods  but  in  taking  smaller  and  more 
frequent  meals.  By  this  means  the  amount  of 
material  present  in  any  portion  of  the  bowel  at  any 
particular  time  will  be  reduced,  the  bowel  will 
never  be  over  distended,  and  will  have  an  oppor- 
tunity gradually  to  recover  its  normal  tone. 

The  proper  plan  for  the  meals  in  such  a  case  is 
to  take  two  principal  meals  and  two  minor  meals. 
The  principal  meals  should  contain  the  chief  part 
of  the  nutriment;  the  minor  meals  should  make 
small  demands  upon  the  digestive  organs ;  the  bulk 
should  be  about  the  same  for  each  of  the  four  meals. 
No  fats  should  be  taken  at  the  minor  meals  and 
nothing  requiring  more  than  two  hours  for  gastric 
digestion.  It  is  best  to  confine  the  minor  meals  to 
fruit  and  cellulose. 


236  COLON  HYGIENE 

The  cellulose  may  be  taken  in  the  form  of  bran 
mush,  bran  cakes,  colax,  (Japanese  sea  weed  or 
Ceylon  moss),  or  laxa,  (sterilized  bran  and  agar- 
agar).  Any  sort  of  fresh  juicy  fruit  may  be  eaten, 
but  bananas,  dates,  dried  figs  and  raisins  should 
be  avoided.  Fresh  figs  or  raw  soaked  purple  figs 
are  excellent.  Soaked  raw  prunes  are  also  very 
good  indeed. 

The  arrangement  of  the  four  meals  as  regards 
time  may  be  the  follov/ing:  first,  breakfast  on  ris- 
ing, say  6:30  a.  m.,  fruit  and  bran;  second  break- 
fast, 9 :00  a.  m. ;  dinner  3 :00  p.  m. ;  fruit  lunch  at 
bedtime.  If  these  hours  are  not  convenient,  some 
other  arrangement  may  be  made,  care  being  taken 
to  avoid  taking  meals  too  near  together. 

The  Use  of  Bran 

Wheat  bran  is  perhaps  the  most  useful  of  all 
food  remedies  for  constipation.  Bran  may  be 
taken  by  itself  or  it  may  be  used  in  many  combina- 
tions. Care  must  be  taken  to  obtain  clean  bran, 
which  is  not  always  easy,  for  the  reason  that  the 
bran  is  usually  mixed  with  much  dirt  and  offal 
removed  from  the  grain.  To  be  fit  for  use,  the 
bran  should  be  taken  from  wheat  which  has  been 
specially  cleansed  and  washed.  The  bran  should 
be  cooked  and  sterilized  to  destroy  any  adhering 
germs. 

Such  bran  only  needs  softening  and  is  ready  for 


DIET  IN  CONSTIPATION  237 

immediate  use.  It  may  be  eaten  as  a  breakfast 
cereal  or  it  may  be  mixed  with  any  other  suitable 
food  such  as  oatmeal,  toasted  flakes,  or  even  mashed 
potatoes  or  boiled  rice. 

Sterilized  bran  may  be  added  to  bread,  biscuit, 
cake  and  breakfast  cakes  in  proportion  of  one- 
fourth  or  even  more.  It  should  be  used  freely  at 
every  meal.  Numerous  excellent  recipes  are  now 
available  for  using  bran  in  various  palatable  and 
efficient  ways. 

Recipes  for  the  Use  of  Bran 

BRAN  AND  OATS 

1  cup  rolled  oats 

1  cup  sterilized  bran 

2  J/2  cups  water 
1  teaspoon  salt 

Heat  the  water  to  boiling.  Add  the  salt,  bran 
and  the  rolled  oats.  Let  boil  five  minutes.  This 
dish  is  a  good  corrective  measure  and  at  the  same 
time  an  excellent  breakfast  food. 

STERILIZED  BRAN 

Look  over  and  remove  foreign  substances  from 
bran  and  place  in  a  rather  shallow  pan  in  a  mod- 
erate oven.  Place  a  pan  of  hot  water  in  the  oven 
to  prevent  burning.  Bake  a  half  hour,  stirring  the 
bran  often  to  prevent  scorching.  Grind  in  a  coffee 
mill. 


238  COLON  HYGIENE 

BRAN   AND  GRANOLA   MUSH 

1  cup  Sterilized  bran 

1  cup  granola 
3  cups  water 

1^  teaspoons  salt 

Mix  the  bran,  granola  and  salt.  Stir  into  the 
boiling  water  and  cook  for  a  few  minutes  directly 
over  the  flame. 

GRAHAM    BREAD 

3  cups  milk  and  water   (equal  parts) 

2  tablespoons  malt  hone}^  or  molasses 
1^  cups  sterilized  bran 

About  2  quarts  whole  wheat  flour 

2  teaspoons  salt 

Y2  yeast  cake 

^  cup  warm  water 

Soak  the  yeast  in  the  warm  water.  Scald  the 
milk  and  cool  to  lukewarm.  Potato  water  may 
be  used  instead  of  the  milk  and  water.  Add  water, 
the  molasses  and  salt,  then  the  softened  yeast.  Mix 
the  flour  and  bran  together  and  stir  into  the  liquids. 
Knead  thoroughly,  and  put  to  rise  in  a  warm  place. 
When  light,  mold  into  a  loaf.  Let  rise  again,  and 
'when  light  bake  in  a  hot  oven  about  one  hour.  De- 
crease the  heat  somewhat  during  the  latter  part  of 
the  baking.  This  makes  3  small  or  2  large  loafs. 
Graham  flour  may  be  used  instead  of  the  whole 
wheat,  in  which  case  less  bran  will  be  needed. 


DIET  IN  CONSTIPATION  239 

BRAN   GRAHAM   BISCUIT 

1  cup  Sterilized  bran 

2  cups  graham  flour 
1  cup  milk 

1  egg 

2  teaspoons  sugar 
'1  teaspoon  salt 

2  tablespoons  butter 
1  teaspoon  soda 

80  minims  hydrochloric  acid  (C.  P.)  (This 
amount  of  soda  and  hydrochloric  acid  is  equivalent 
to  4  teaspoons  baking  powder.) 

Mix  the  flour,  bran,  sugar,  and  salt  together. 
Beat  the  egg  slightly  and  add  to  the  milk.  Dis- 
solve the  soda  in  the  milk,  and  add  the  melted  but- 
ter. Lastly,  add  the  hydrochloric  acid.  Turn 
very  quickly  into  the  dry  ingredients.  Mix  lightly 
but  quickly.  Turn  upon  a  molding  board  and 
shape  with  a  biscuit  cutter  and  bake  fifteen  to 
twenty  minutes  in  a  hot  oven. 

If  baking  powder  is  used,  omit  the  hydrochloric 
acid  and  the  soda,  and  proceed  as  follows:  Mix 
the  dry  ingredients  together,  beat  the  egg  slightly, 
and  add  to  the  milk.  Stir  the  liquids  into  the  dry 
ingredients  the  same  as  for  cream  biscuits.  Turn 
out  upon  a  slightly  floured  molding  board  and  roll 
to  one-half  inch  in  thickness.  Cut  into  shape  with 
the  biscuit  cutter  and  bake  in  a  hot  oven. 


240  COLON  HYGIENE 

BRAN   GEMS 

1  cup  Sterilized  bran 

1  cup  graham  flour 

14,  cup  milk 

3  tablespoons  melted  butter 

1  teaspoon  salt 

1  egg 

1  tablespoon  sugar 

^  teaspoons  soda 

60  minims  hydrochloric  acid  (C.  P.)  (This 
amount  of  soda  and  hydrochloric  acid  is  equivalent 
to  3  teaspoons  of  baking  powder.) 

Mix  the  bran,  flour,  salt  and  sugar  together. 
Beat  the  egg,  add  the  milk  and  one-half  of  the  dry 
ingredients.  Stir  in  the  hydrochloric  acid.  Mix 
well  and  add  the  melted  butter.  Sift  the  soda  with 
the  remaining  half  of  the  dry  ingredients  and  stir 
into  the  batter.  Turn  into  buttered  muffin  pans 
and  bake  in  a  hot  oven  twenty  to  thirty  minutes. 

BROSE 

Mix  equal  parts  of  cornmeal,  steel-cut  oats,  and 
sterilized  bran.  Stir  into  three  times  its  bulk  of 
boiling  water.  As  soon  as  the  mixture  thickens,  it 
is  ready  to  eat.  Should  not  cook  over  four  or  five 
minutes.  This  simple  mixture  will  be  found  a  most 
efficient  and  satisfactory  laxative  breakfast  food. 
Eat  with  cream,  butter,  fresh  or  stewed  fruit. 


Baths  and  Other  Home  Treatments 
for  Constipation 

Water  may  render  great  service  in  constipation, 
through  the  general  improvement  in  health  which 
may  be  secured  by  its  sytematic  use.  Cold  water 
is  of  the  greatest  service.  The  short  spinal  douche 
is  one  of  the  most  effective  means  which  can  be 
employed  for  improving  the  tone  of  the  nervous 
system. 

The  inactive  skin,  due  to  the  general  saturation 
of  the  body  with  toxins,  is  an  indication  for  sweat- 
ing baths.  In  constipation  these  should  be  made 
short,  however,  barely  long  enough  to  stimulate  the 
skin  to  vigorous  perspiration,  and  should  be  im- 
mediately followed  by  a  short  general  cold  applica- 
tion, including  a  cold  douche  to  the  spine,  abdomen 
and  legs.  Short,  cold  applications  applied  to  the 
surface  cause  reflex  contraction  of  the  internal  in- 
voluntary muscles.  It  is  for  this  reason  that  plac- 
ing the  feet,  sometimes  even  the  hands,  in  cold 
water  will  often  produce  a  desire  to  empty  the 
bladder,  through  stimulation  of  the  urinary  centre. 

The  defecating  centre  and  intestinal  rruscles  may 
be  stimulated  in  the  same  way.  Various  local  ap- 
plications are  of  great  service  in  improving  the  tone 
of  the  bowels,  though  local  cold  applications  must 
be  used  with   great   discretion   and    with    careful 

241 


242  COLON  HYGIENE 

knowledge  of  the  exact  nature  of  the  case;  for  the 
tendency  of  cold  to  produce  contraction  of  the  in- 
voluntary muscles  leads  to  an  aggravation  of  the 
condition  in  colitis  vi^ith  spastic  constipation. 

Of  the  many  different  modes  of  applying  cold 
water,  which  may  be  of  service,  the  following  are 
especially  recommended : 

The  Exercise  Bath 

Swimming  is  undoubtedly  the  best  form  of  bath, 
as  well  as  the  best  form  of  exercise  for  general 
hygiene  effects.  Unfortunately,  facilities  for  this 
natural  exercise  bath  are  not  available  for  the  ma- 
jority of  persons,  especially  during  the  winter  sea- 
son. Some  time  ago,  it  occurred  to  the  writer  that 
most  of  the  advantages  of  the  swimming  bath  might 
be  secured  by  combining  exercise  wnth  the  cold  bath 
in  an  ordinary  bath  tub.  The  following  is  a  de- 
scription of  the  rowing  or  surf  bath  as  it  is  in  use 
at  the  Battle  Creek  Sanitarium: 

The  patient  sits  in  a  bath  tub  partly  filled  with 
water,  and  dips  water  over  himself  while  at  the 
same  time  executing  the  movements  of  rowing.  The 
temperature  of  the  water  may  be  100°  F.  at  the 
start,  but  should  be  rapidly  lowered  by  opening  the 
cold  water  faucet  and,  if  necessary,  letting  out  part 
of  the  water  while  the  cold  water  is  running  in. 
The  rowing  and  dipping  apparatus  consists  of  a 
pair  of  handles  to  which  is  attached  a  dipper  and 


The  Bath  Exerciser,  or  Surf  Bath 


The   Pouring   Douche 


BATHS  AND  OTHER  HOME  TREATMENTS  243 

> 

a  rubber  cord.  The  bather  fills  the  bowl  as  he 
reaches  forward,  then  dashes  the  water  over  his 
body  as  he  pulls  the  bowl  towards  his  chest  and 
bends  his  body  back.  Strokes  are  made  at  the  rate 
of  about  thirty  per  minute.  From  one  hundred  to 
one  hundred  and  fifty  strokes  are  made.  The  tem- 
perature of  the  water  grows  continually  colder  to 
the  close  of  the  bath  or  until  pipe  temperature  is 
reached.  A  temperature  of  70°  F.  to  65°  F.  is 
easily  borne,  and  one  finishes  the  bath  with  the 
same  delightful  sensation  of  warmth  and  glow 
which  one  feels  after  a  swim  in  the  surf.  The  tem- 
perature of  the  water  is,  of  course,  under  perfect 
control,  an  advantage  over  sea  bathing;  and  the 
work  done  may  be  made  as  vigorous  as  one  desires. 

This  exercise  bath  is  most  excellent  for  persons 
suffering  from  constipation.  The  impact  of  the 
cold  water  upon  the  surface  of  the  abdomen  re- 
flexly  stimulates  intestinal  activity. 

The  exercise  bath  is  especially  valuable  in  cases 
of  obesity.  Both  the  exercise  and  the  cold  water 
help  to  burn  up  the  excessive  accumulation  of  fat 
in  the  abdominal  wall  and  within  the  abdomen. 

The  Cold  Douche 

A  short  cold  douche  to  the  lower  part  of  the 
back,  buttocks,  abdomen  and  feet.  The  tempera- 
ture should  be  70°  to  50°  F.,  and  the  duration  ten 
to  thirty  seconds.     With  patients  who  are  not  ac- 


244  COLON  HYGIENE 

customed  to  applications  of  cold  water,  the  tem- 
perature of  the  douches  should  at  first  not  be  lower 
than  70°.  This  should  be  gradually  lowered  at 
each  application  until  the  temperature  of  60°  to 
50°  is  reached.  In  general,  the  douche  should  be 
preceded  by  a  short  hot  bath  to  prepare  the  patient 
for  the  cold  application,  and  to  secure  prompt  re- 
action, which  is  still  further  encouraged  by  exer- 
cise after  the  bath. 

The  Simultaneous  Hot  and  Cold  Douche 

A  very  excellent  form  of  bath  especially  adapted 
to  cases  of  constipation,  is  the  simultaneous  warm 
shower  bath  (100°  F.),  with  short  cold  douche. 
to  the  abdomen.  The  warm  shower  bath  should 
be  applied  for  half-a-minute  so  that  the  skin  will 
be  thoroughly  warm  first,  and  the  cold  spray  or 
broken  jet  should  be  applied  to  the  abdomen  with- 
out interrupting  the  warm  shower.  The  tempera- 
ture of  the  spray  should  be  70°  to  50°.  The  dura- 
tion of  the  cold  application  should  be  not  more 
than  a  minute.  At  the  end  of  the  bath  a  short 
general  cold  application  lasting  no  more  than  ten 
to  fifteen  seconds  should  be  made  to  secure  reaction, 
and  thus  fix  the  blood  in  the  skin. 

Abdominal  Pouring  Douche 

When  a  douche  apparatus  is  not  available,  a 
very  efficient  abdominal  douche  may  be  applied  in 


Applying   a    Wet   Girdle 


BATHS  AND  OTHER  HOME  TREATMENTS  245 

an  ordinary  bath  tub.  A  hot  bath  at  the  tempera- 
ture of  102°  to  103°  should  be  applied  for  one  to 
three  minutes.  Then  the  outlet  should  be  opened 
and  cold  water  should  be  poured  on  the  abdomen 
while  the  water  is  running  out.  By  lifting  the  dip- 
per to  the  height  of  five  or  six  feet  a  sufficient  de- 
gree of  force  may  be  obtained  to  produce  a  decided 
reflex  effect.  The  temperature  of  the  water  may 
vary  from  60°  to  ice  cold,  the  temperature  being 
gradually  lowered  as  the  patient  becomes  accus- 
tomed to  the  cold  application. 

Hot  Sitz  and  Cold  Pour 

The  patient  sits  in  water  at  a  temperature  of 
102°  or  103°  for  two  or  three  minutes,  then  leans 
back  in  the  tub  while  the  attendant  pours  cold  water 
70°  to  50°  over  the  abdomen  for  half  a  minute. 

Rubbing  Cold  Sitz  Bath 

In  this  bath  the  patient  sits  in  water  at  a  tem- 
perature of  75°  to  55°  for  two  minutes,  rubbing 
himself  vigorously  meanwhile.  This  bath  produces 
a  powerful  reflex  influence  upon  the  intestines,  es- 
pecially in  the  colon,  and  is  frequently  followed 
soon  after  by  a  desire  to  defecate.  The  patient 
should  rub  himself  continually  during  the  bath, 
and  the  feet  may  be  kept  in  hot  water  if  there  is 
a  tendency  to  chilliness.  The  shoulders  should  be 
covered  by  a  woolen  blanket. 


246  COLON  HYGIENE 

The  Sedative  Sitz  Bath 

A  bath  at  the  temperature  of  from  60°  to  70° 
for  fifteen  to  twenty  minutes  produces  powerful  and 
prolonged  contraction  of  internal  muscular  struc- 
tures. This  bath  is  useful  in  diarrhoea,  and  is  one 
of  the  most  efficient  means  of  improving  the  tone 
of  the  abdominal  muscles  and  of  an  atonic  colon. 
This  bath  should  not  be  given  in  cases  of  spastic 
constipation.  In  general,  prolonged  cold  baths  of 
any  sort,  (that  is,  baths  longer  than  two  or  three 
minutes),  are  aggravating  in  this  condition. 

Alternate  Applications  to  the  Abdomen 

A  hot  fomentation  to  the  abdomen  for  five  to 
ten  minutes,  followed  by  a  cold  application  for  one 
minute,  is  an  excellent  means  of  stimulating  peristal- 
sis and  improving  the  muscular  tone.  The  cold 
application  may  consist  of  a  compress  of  ice  water, 
but  the  most  effective  method  is  to  rub  the  abdomen 
with  a  smooth  piece  of  ice.  The  effect  of  this  ap- 
plication is  increased  by  repeating  the  alternation 
two  or  three  times  in  succession. 

The  Wet  Girdle 

This  is  a  simple  method  which  has  been  used 
for  centuries  by  the  peasantry  of  Europe.  The  ab- 
dominal girdle  consists  of  a  coarse  towel  of  three 
yards  in  length,  half  of  which  is  wet,  the  other  half 
remaining  dry.     Beginning  with  the  wet  end,  the 


BATHS  AND  OTHER  HOME  TREATMENTS    247 

towel  is  wound  round  the  trunk  of  the  body,  great 
care  being  taken  to  see  that  it  fits  the  skin  snugly. 
Outside  the  towel  a  flannel  bandage  is  applied.  The 
towel  should  be  changed  before  it  becomes  dry.  It 
should  be  worn  night  and  day  to  secure  the  most 
pronounced  effect.  The  mackintosh  or  oiled  mus- 
lin, often  applied  with  the  moist  bandage,  should 
be  omitted  when  it  is  the  purpose  to  relieve  con- 
stipation. 

Fomentation  to  the  Abdomen 

The  abdominal  fomentation  is  a  capital  means 
for  use  in  spastic  constipation,  the  result  of  colitis, 
and  when  the  ileocecal  valve  is  in  a  state  of  spas- 
modic contraction  due  to  chronic  appendicitis  or 
ovarian  disease.  In  general  the  fomentation  is 
highly  useful  in  all  cases  of  constipation  accom- 
panied by  pain  in  the  abdomen,  no  matter  what  the 
cause. 

The  electric  fomentation  heater  is  a  convenient 
means  of  heating  a  fomentation  compress. 

The  best  time  for  applying  the  fomentation  is 
soon  after  breakfast,  or  shortly  before  the  regular 
time  for  moving  the  bowels.  Applications  may  be 
made  with  great  advantage  two  or  three  times 
daily,  or  at  least  morning  and  night,  so  as  to  relax 
the  colon  several  times  during  the  day. 

In  very  pronounced  cases  of  colitis,  with  spastic 
constipation,  a  short  very  hot  bath  is  of  great  ser- 
vice.    The  duration  of  the  bath  should  not  be  more 


248  COLON  HYGIENE 

than  two  to  four  minutes.  It  produces  debility 
and  anemia  if  long  continued  and  often  repeated. 
The  effect  of  hot  applications  is  to  lessen  the  ir- 
ritability of  the  nerve  centers,  and  thus  to  relieve 
the  intestinal  spasm  vi^hich  may  be  due  to  conges^ 
tion  or  inflammation  of  the  appendix,  ovaries, 
bladder,  rectum  or  gall-bladder,  or  still  more  often, 
to  colitis. 

Combined  Hot  Bath  and  Hot  Douche 

Perhaps  the  most  effective  measure  for  the  relief 
of  intestinal  spasms,  such  as  sometimes  occurs  in 
mu co-membranous  colitis,  is  a  w^arm  bath  (100°  F.) 
combined  M^ith  a  very  hot  spray  to  the  abdomen. 
The  vt^ater  should  be  allowed  to  fall  on  the  abdo- 
men in  very  fine  streams  with  very  little  force,  at 
2-  temperature  of  115°  to  120°.  The  duration  of 
the  application  should  be  two  to  five  minutes.  It 
should  be  followed  by  a  cold  application  at  a  tem- 
perature about  80°  for  one  or  two  minutes. 

The  Hot  Sitz 

The  hot  sitz  bath  at  a  temperature  of  112°  to 
118°,  duration  two  to  three  minutes,  cannot  be 
too  highly  praised  as  a  measure  of  the  highest  value 
for  use  in  the  treatment  of  reflex  and  spastic  con- 
stipation, with  or  without  colitis.  After  the  sitz 
no  cold  application  is  made.  The  best  time  for  the 
bath  is  on  rising  in  the  morning. 


Photophore    (above)    and    Thermophore    (below) 


BATHS  AND  OTHER  HOME  TREATMENTS   249 

The  Photophore,  and  the  Electric 
Thermophore 

These  are  measures  of  great  value  in  the  treat- 
ment of  spastic  and  reflex  constipation,  and  are 
especially  useful  in  cases  in  which  pain  is  a  pro- 
nounced symptom  and  a  cause  of  reflex  spasm.  The 
applications  should  be  made  morning  and  night  in 
place  of  the  fomentation,  and  are  much  more  ef- 
fective. 

The  Enema 

There  are  unquestionably  certain  cases  in  which 
the  colon  has  become  so  crippled  by  inflammations, 
stretchings,  distortions,  adhesions  and  the  degenera- 
tion of  its  muscular  structures,  and  consequent 
weakening  of  its  contractile  powers,  that  it  can  no 
longer  be  made  to  perform  its  functions,  even  by 
the  use  of  such  accessories  as  act  as  mechanical  or 
physiological  aids.  In  such  cases  and  in  certain 
emergency  cases,  the  judicious  use  of  the  enema  is 
not  only  helpful,  but  sometimes  necessary.  For 
example,  in  cases  of  senile  constipation,  where  as 
the  result  of  long  continued  colitis,  the  muscular 
walls  are  thin  and  greatly  stretched,  while  the 
colon  itself  has  become  abnormally  redundant  and 
folded  upon  itself,  the  daily  or  frequent  use  of  the 
enema  may  be  required. 

The  best  means  of  administering  the  enema  is 
the  fountain  syringe.       The  tube  should  be    long 


250  COLON  HYGIENE 

enough  so  that  the  reservoir,  if  necessary,  may  be 
raised  to  a  height  of  five  or  six  feet  above  the  pa- 
tient. When  it  is  desired  to  stimulate  the  bowel 
to  immediate  contraction,  the  reservoir  should  be 
placed  high,  but  when  the  purpose  is  to  introduce 
as  large  quantity  of  v^^ater  as  possible  into  the  colon, 
and  to  have  it  retained  for  a  time,  the  reservoir 
should  be  placed  at  a  height  not  exceeding  two  or 
three  feet. 

The  position  of  the  patient  during  the  adminis- 
tration of  an  enema  is  not  a  matter  of  very  great 
importance.  In  cases  in  which  the  pelvic  colon  is 
low  down  in  the  pelvis,  as  is  shown  by  examination, 
it  is  well  to  put  the  patient  in  a  knee-chest  position. 
The  water  should  be  introduced  very  slowly.  Or- 
dinarily, however,  the  patient  may  lie  upon  the 
back  or  either  side,  or  the  enema  may  even  be  ad- 
ministered standing.  The  water  quickly  finds  its 
way  along  the  colon,  no  matter  what  the  position 
of  the  patient  may  be. 

The  use  of  the  colon  tube  is  quite  unnecessary. 
Indeed,  as  the  writer  learned  long  ago  by  experience, 
and  as  has  been  abundantly  proved  by  examination 
with  the  X-ray,  the  colon  tube  can  rarely  ever  be 
introduced  beyond  the  rectum.  It  is  arrested  at 
the  pelvi-rectal  fold,  and  simply  returns  and  coils  it- 
self up  in  the  rectum.  A  tube  long  enough  to  pass 
the  water  through  the  anus  is  as  useful  as  the  longest 
colon  tube,  unless  the  long  tube  is  passed  into  the 
pelvic  colon  past  the  ileosplenic  flexure,  a  procedure 


BATHS  AND  OTHER  HOME  TREATMENTS   251 

which  is  rarely  required,  and,  of  course,  should  only 
be  undertaken  by  a  physician. 

The  enema  may  be  employed  in  a  variety  of 
ways  adapted  to  different  occasions  and  purposes, 
and  it  may  be  repeated  as  many  times  as  may  be 
necessary.  Warm  water  dissolves  hardened  fecal 
matters  much  more  readily  than  cold  water,  yet  in 
some  cases  it  may  be  necessary  to  repeat  the  enema, 
at  intervals  of  fifteen  to  twenty  minutes,  five  or 
six  times  before  the  effect  desired  is  obtained.  When 
used  for  the  purpose  of  softening  hardened  fecal 
matters,  the  water  should  be  introduced  slowly, 
and  the  patient  should  be  instructed  to  retain  as 
much  as  possible.  The  enema  should  be  repeated 
as  long  as  the  water  contains  fecal  matters  when 
returned. 

The  Hot  Water  Enema 

The  temperature  of  the  water  should  be  105° 
to  115°  F.  The  quantity  may  be  from  one  to  three 
pints.  This  is  preferable  in  cases  of  colitis  and  when 
abdominal  pain  or  tenderness  is  present. 

The  Hot  Soap  Enema 

The  addition  of  soap  to  the  water  somewhat  in- 
creases its  power  to  dissolve  hardened  feces,  al- 
though the  advantage  of  its  use  is  not  so  great  as 
might  be  supposed.  The  amount  of  soap  should 
be  sufficient  only  to  make  very  weak  suds,  as  other- 


252  COLON  HYGIENE 

wise,  it  may  be  irritating,  especially  if  the  soap  con- 
tains a  considerable  amount  of  free  alkali.  Ordinary 
soap  is  best  for  the  purpose. 

The  Hot  Saline  Enema 

Half  an  ounce  of  salt  is  added  to  two  quarts  of 
water  at  a  temperature  of  105°  to  115°  F. 

The  purpose  of  the  addition  of  salt  is  to  lessen 
the  irritation  of  the  mucous  membrane.  It  is  of 
special  use  in  cases  of  colitis,  in  which  the  enema 
is  administered  for  the  purpose  of  removing  mucous 
and  relieving  spasms  of  the  intestine.  The  applica- 
tion should  be  repeated  until  no  mucous  returns 
with  the  water.  Care  must  be  taken  to  secure 
evacuation  of  the  water  so  as  to  avoid  retention  of 
a  large  amount  of  salt,  which  may  do  serious  in- 
jury. 

The  Cold  Water  Enema 

A  cold  application  to  the  interior  of  the  bowel 
is  one  of  the  most  powerful  means  of  stimulation 
which  can  be  safely  employed.  Half  a  pint  of  water 
at  a  temperature  of  50°  will  usually  set  up  a  very 
strong  and  painful  contraction  of  the  lower  bowel. 
It  is  on  this  account  necessary  to  begin  with  a  mod- 
erate temperature.  The  first  enema  should  have 
a  temperature  of  80°  to  85°  F.  The  temperature 
may  be  lowered  on  each  application  five  to  ten  de- 
grees, or  until  sufficient  powerful  contractions  are 


BATHS  AND  OTHER  HOME  TREATMENTS.  253 

produced  to  expel  quickly  the  water  introduced.  By 
gradually  reducing  the  temperature  in  this  way, 
one  as  low  as  40°  may  finally  be  used  without 
causing  excessive  pain.  Such  low  temperatures 
are  very  seldom  required  except  in  dysentery,  in 
which  they  often  render  great  service. 

The  cold  enema  is  of  special  use  in  cases  in  which 
the  colon  has  become  gradually  dilated  and  has  be- 
come atonic,  and  contracts  with  insufficient  force 
to  expel  its  contents.  In  such  cases  a  warm  or  hot 
enema  is  usually  retained.  By  following  the  warm 
enema  with  half  a  pint  or  a  pint  of  water  at  60 '^ 
to  70°  F.,  prompt  contraction  of  the  bowel  almost 
invariably  follows,  with  expulsion  of  the  bowel  con- 
tents. This  is  a  very  important  practical  use  of  the 
cold  enema,  as  the  retention  of  the  water  in  cases 
in  which  the  bowel  is  filled  with  putrefying  fecal 
matters  is  very  often  followed  by  very  unpleasant 
and  even  serious  effects,  through  the  absorption  of 
enormous  quantities  of  toxic  substances,  which  are 
dissolved  by  the  water  and  brought  into  contact 
with  the  absorbing  surface  of  the  bowel.  In  such 
cases  the  hot  enema  should  be  immediately  followed 
by  a  small  cold  enema,  and  the  cold  enema  should 
be  repeated  several  times,  if  necessary. 

The   Oil  Enema 

The  amount  of  oil  required  is  four  to  sixteen 
ounces.     Either  pure  olive  oil  or  any  sweet  oil  may 


254  COLON  HYGIENE 

be  employed.  The  latter  is  just  as  good  as  the 
former,  and  is  less  likely  to  produce  nausea  and 
vomiting,  which  sometimes  follows  the  use  of  olive 
oil  of  an  inferior  grade.  The  temperature  of  the  oil 
should  be  104°.  As  a  means  of  softening  hardened 
feces,  oil  is  no  better  thail  water;  in  fact,  accord- 
ing to  the  writer's  experience,  it  is  less  efficient.  It 
is  useful,  however,  as  a  means  of  lubricating  the 
lower  bowel,  and  when  introduced  at  night  pre- 
vents hardening  and  drying  of  the  feces.  For  this 
purpose  4  to  6  ounces  should  be  introduced  at  night. 
When  used  for  the  purpose  of  lubrication  only,  a 
good  plan  is  to  administer  the  oil  before  breakfast. 
This  is  an  excellent  means  of  securing  a  thorough 
evacuation  of  the  colon. 

Sugar  and  Water  Enema 

Sugar  is  a  powerful  stimulant  of  the  colon.  A 
very  old-fashioned  remedy  is  the  introduction  of 
molasses  into  the  colon.  To  half  a  pint  or  pint  of 
molasses  an  equal  quantity  of  hot  water  is  added. 
A  prompt  action  of  the  colon  usually  follows  the 
introduction  of  this  mixture.  The  writer  has  for 
years  used  malt  sugar  for  this  purpose,  and  with 
most  satisfactory  results.  The  malt  sugar  not  only 
acts  as  a  stimulant  to  the  bowel,  but  at  the  same 
time  furnishes  valuable  nourishment.  Four  ounces 
of  malt  sugar  should  be  added  to  a  pint  of  water. 


BATHS  AND  OTHER  HOME  TREATMENTS   255 

ParafHn   Oil   Enema 

Liquid  paraffin,  or  paraffin  oil,  may  be  used  as 
an  enema  in  place  of  olive  oil  and  other  oils,  and 
has  the  advantage  that  it  does  not  produce  nausea 
or  other  unpleasant  symptoms.  Paraffin  oil  is  bet- 
ter than  any  animal  or  vegetable  oil,  for  the  reason 
that  it  is  not  a  fat,  and  is  not  absorbed,  neither  will 
it  undergo  fermentation.  The  oil  enema  often 
causes  nausea,  loss  of  appetite,  and  coating  of  the 
tongue.  This  may  be  avoided  by  the  use  of  paraffin 
oil.  Only  the  specially  purified  refined  vi^hite  Rus- 
sian oil  should  be  used. 

The  Alum  Enema 

In  cases  in  which  the  bowels  cannot  be  made  to 
move  promptly  by  other  means,  alum  has  been  found 
to  be  effective.  A  teaspoonful  of  powdered  alum 
is  used  in  a  quart  of  water.  By  using  cool  water 
70°     to  80°  the  effect  may  be  increased. 

The   Glycerine  Enema 

Pure  glycerine  introduced  into  the  rectum  in  a 
quantity  of  one  to  four  ounces  is  a  useful  means 
of  stimulating  bowel  movements,  by  bringing  about 
the  defecating  reflex.  When  pure  glycerine  is 
found  to  lead  to  too  much  irritation,  as  is  some- 
times the  case,  it  should  be  used  with  an  equal 
quantity  of  water. 


256  COLON  HYGIENE 

The  Cold  Rectal  Douche 

By  introducing  cold  water  into  the  rectum  with 
considerable  force,  a  most  powerful  stimulation  may 
be  produced.  The  temperature  of  the  water  should 
be  70°  to  80°  F.  If  the  stream  furnished  by  the 
ordinary  fountain  douche  has  not  sufficient  force 
for  this,  a  bulb  syringe  is  necessary. 

In  administering  the  rectal  douche  a  return  tube 
should  always  be  used,  so  that  the  rectum  will  not 
be  over-distended.  A  small  tube  should  be  connected 
with  the  syringe,  and  a  large  one  should  be  intro- 
duced alongside  it,  to  counteract  over-distension  of 
the  rectum.  When  the  powerful  stimulation  of  the 
rectal  douche  is  required,  it  is  not  desired  to  secure 
the  stimulation  which  results  from  distention  of  the 
rectum,  for  in  these  cases  the  rectum'  is  always  re- 
laxed, and  has  to  a  certain  degree  lost  its  contractile 
power.  It  is  desired  only  to  obtain  the  stimulating 
effects  produced  by  a  low  temperature  and  the  im- 
pact of  a  stream  of  water  introduced  with  consider- 
able force,  the  effect  of  such  an  application  is  to 
produce  almost  immediately  a  very  strong  defecat- 
ing reflex,  with  contraction  of  the  pelvic  colon  and 
forcible  expulsive  efforts. 

It  is  well  that  the  enema  tube  should  be  intro- 
duced its  full  length  and  should  be  directed  some- 
what backward,  so  that  the  stream  of  water  may 
be  received  upon  the  upper  part  of  the  rectum  and, 
if  possible,  reach  the  pelvi-rectal  fold. 


BATHS  AND  OTHER  HOME  TREATMENTS  257 

In  cases  in  which  the  sensibility  of  the  rectum  is 
largely  lost,  this  measure  affords  a  very  excellent 
means  of  restoring  normal  sensibility.  In  extreme 
cases  the  alternating  rectal  douche  may  be  employed, 
using  first  water  at  a  temperature  of  115°,  then 
water  at  a  temperature  of  60°  to  70°.  In  some 
extreme  cases  the  temperature  of  the  water  is  as 
low  as  40°  or  50°.  The  application  should  be 
made  every  ten  seconds. 

Injury  from   Drug   Laxatives 

While  the  temporary  use  of  medicinal  laxatives  is 
sometimes  necessary,  and  always  justifiable  when 
required  as  an  emergency  means,  there  can  be  no 
doubt  that  the  continued  use  of  drugs  of  any  sort 
is  highly  injurious  to  the  intestines,  and  in  many 
cases  to  other  organs  with  which  the  drug  com.es 
in  contact,  particularly  the  liver  and  kidneys,  which 
are  burdened  with  the  elimination  of  a  certain  part 
of  the  drugs  employed. 

All  laxative  drugs  are  irritant  poisons.  They 
affect  the  stomach  as  well  as  the  colon  and  small 
intestine.  Their  long  continued  use  in  time  gives 
rise  to  gastric  and  intestinal  catarrh,  colitis  and  the 
varied  evils  which  accompany  these  disorders,  es- 
pecially hemorrhoids,  appendicitis,  intestinal  tox- 
emia and  certain  aggravation  of  the  constipation 
which  they  are  given  to  relieve. 

Most  drugs  which  act  upon  the  bowels  produce 


258  COLON  HYGIENE 

their  effect  only  after  having  been  absorbed  and 
circulated  through  the  blood.  This  has  been  proved 
to  be  true  even  in  the  case  of  saline  laxatives,  which 
are  absorbed  in  the  upper  part  of  the  intestine,  and 
acting  through  the  nerve  centers  controlling  the 
colon,  produce  a  laxative  effect  long  before  the  drug 
has  reached  the  colon  through  the  intestine.  •■ 

The  effects  of  many  other  laxative  drugs  may  be 
produced  by  injection  under  the  skin. 

It  is  thus  evident  that  the  action  of  laxative 
drugs  is  not  confined  to  the  intestine,  but  through 
absorption  into  the  blood  stream  these  irritating 
substances  are  brought  into  contact  with  all  the 
tissues. 

Among  the  most  largely  used  laxative  drugs  are 
aloes,  senna,  rhubarb  and  cascara.  All  of  these 
drugs  contain  substances  which  are  irritant  poisons 
derived  from  anthracene. 

According  to  Levin,  when  a  preparation  of  aloes 
is  "employed  for  a  length  of  time,  there  occurs,  in 
consequence  of  the  persistent  congestion  of  the 
descending  colon  and  rectum,  dilation  of  the  hemor- 
rhoidal veins."  Fallopius  said  that  "out  of  a  hun- 
dred persons  who  make  habitual  use  of  aloes,  ninety 
are  attacked  by  hemorrhoids." 

Sollman  says  that:  "When  injected  hypoder- 
mically,  aloin  causes  a  tubular  nephritis,  acute 
Bright's  disease."  The  extensive  use  of  this  ir- 
ritating drug  in  various  popular  laxative  drugs  and 
much  advertised  nostrums  may  well  be  one  of  the 


BATHS  AND  OTHER  HOME  TREATMENTS  259 

active  causes  of  the  alarming  increase  in  disease 
of  the  kidneys,  which  has  occurred  within  the  last 
thirty  years. 

Rhubarb,  according  to  Sollman,  contains  a  poison 
that  produces  a  secondary  constipation. 

Saline  laxatives  throw  an  enormous  burden  upon 
the  kidneys,  and  when  often  repeated  give  rise  to 
a  very  obstinate  colitis. 

They  also  impair  digestion,  in  time,  setting  up 
gastric  and  duodenal  catarrh  and  producing  achylia^ 
a  condition  in  which  the  stomach  glands  produce 
no  hydrochloric  acid,  thus  leaving  both  the  stomach 
and  the  intestine  a  prey  to  the  various  sorts  of  per- 
nicious bacteria  which  are  constantly  finding  their 
way  into  the  stomach  through  the  mouth,  especially 
through  the  medium  of  flesh  foods,  milk,  and 
cheese. 

The  effects  of  laxative  mineral  vv/-aters  are  es- 
sentially the  same  as  those  of  saline  laxatives,  which 
they  are. 

Saline  laxatives  are  particularly  injurious  to  bed- 
ridden patients,  because  of  the  slow  empt>ang  of 
the  stomach  usual  in  such  cases,  in  consequence  of 
which  the  stomach  is  more  than  ordinarily  damaged. 

Calomel,  a  drug  which  since  the  time  of  Paracel- 
sus has  been  extensively  used  as  a  laxative,  and  in 
conditions  resulting  from  constipation,  one  of  the 
most  common  of  which  is  popularly  known  as 
"biliousness,"  is  often  a  potent  remedy,  affording 
prompt  relief,  but  when  its  use  is  often  repeated,  it 


260  COLON  HYGIENE 

becomes  a  highly  dangerous  and  injurious  agent. 
All  metallic  drugs  are  combated  by  the  liver, 
which  absorbs  as  much  as  possible  of  the  poison 
into  its  own  tissues  as  a  means  of  protecting  the 
rest  of  the  body.  Thus  the  liver  is  particularly 
subject  to  injury.  Bennett,  of  Edinburgh,  showed 
more  than  a  hundred  years  ago  that  calomel  does 
not  increase  the  action  of  the  liver,  and  his  observa- 
tions have  been  in  recent  years  confirmed  by  Ruther- 
ford and  others. 

Every  chronic  sufferer  from  constipation  should 
know  that  there  is  no  laxative  drug  known,  the 
constant  use  of  which  is  harmless.  All  laxative  drugs 
are  irritants.  The  more  certain  their  action  as  laxa- 
tives, the  more  certainly  will  their  continuous  use 
for  any  length  of  time  be  followed  by  serious  in- 
jury. Said  an  eminent  German  physician,  "Nothing 
is  so  bad  as  the  chronic  use  of  laxative  drugs." 

/  .  . 

White  Russian  Paraffin  Oil 

Dr.  Neville  Wood  some  years  ago,  suggested  the 
use  of  pure  liquid  paraffin,  a  product  of  petroleum. 
Schmidt,  Lane  and  others  have  made  much  use  of 
this  preparation  and  have  noted  excellent  results. 
The  writer  has  made  use  of  this  remedy  in  hundreds 
of  cases  with  great  success. 

Petroleum  oil,  as  found  in  its  native  state,  has 
been  long  used  by  primitive  people  and  pioneers 
as   a    remedy    for    constipation.      Arbuthnot    Lane 


BATHS  AND  OTHER  HOME  TREATMENTS   261 

informed  the  writer  that  he  had  learned  from 
authentic  sources  that  petroleum  has  been  used  for 
centuries  by  the  Kaffirs,  and  it  is  well  known  that 
it  was  employed  as  a  domestic  remedy  in  America 
long  before  it  was  used  for  illuminating  purposes. 
The  oil  was  found  floating  upon  the  waters  of  cer- 
tain streams,  and  was  collected  and  sold  by  itinerant 
peddlers,  and  occasionally  in  drug  stores. 

Paraffin  is  not  acted  upon  by  any  of  the  digestive 
juices,  and  is  not  absorbed.  It  prevents  the  drying 
of  the  feces,  lubricates  the  colon  and  rectum,  and 
also  to  some  extent  prevents  the  absorption  of  toxins 
from  the  intestine.  It  may  possibly  to  some  degree 
encourage  fermentation  by  preventing  the  absorp- 
tion of  digesting  food  stuffs,  and  in  the  same  way 
may  tend  to  encourage  putrefaction.  The  writer, 
on  this  account,  has  found  it  of  use  to  combine  it 
with  agar-agar,  so  as  to  facilitate  intestinal  action 
by  increasing  the  bulk  of  the  feces.  By  the  addition 
of  some  syrup,  carbohydrates  and  concentrated  fruit 
juice,  honey,  or  malt  syrup,  the  tendency  to  putre- 
faction in  the  colon  may  be  antagonized,  and  there- 
by any  possible  evil  results  avoided. 

Paraffin  oil  will  not  remedy  every  defect  in  the 
(defecating  process  and  hence  will  not  cure  ever}'' 
case  of  constipation,  but  it  comes  nearer  being  a 
panacea  than  any  remedy  which  has  heretofore 
been  found,  and  does  meet  a  surprisingly  large 
number  of  indications.  After  a  careful  study  of 
its  effects  in  several  thousand  cases,  the  writer  feels 


262  COLON  HYGIENE 

justified  in  saying  with  much  confidence  that  paraf- 
fin oil  may  be  relied  upon  to  accomplish  the  follow- 
ing results  in  the  treatment  of  chronic  constipation: 

1.  It  lubricates  the  alimentary  canal  through- 
out its  whole  length.  In  a  large  number  of  cases 
of  constipation  there  is  an  excessive  absorption  of 
water  from  the  colon,  leaving  the  feces  dry  or  pasty 
and  adhesive.  An  examination  of  the  rectum  and 
pelvic  colon  in  such  cases  shows  the  mucous  mem- 
brane to  be  deficiently  lubricated  by  mucus,  and 
covered  with  flakes  of  adhering  feces.  The  use 
of  half  an  ounce  or  an  ounce  of  paraffin  oil  at  bed- 
time, and  half  as  much  an  hour  before  each  meal, 
will  in  two  or  three  days  change  the  condition 
completely,  as  shown  by  proctoscopic  examination. 

2.  This  mechanical  lubricating  action  of  paraffin 
is  highly  important  in  overcoming  kinks  due  to  re- 
dundance or  to  adhesions  resulting  from  colitis  or 
other  causes.  When  the  mucous  surface  is  kept 
well  lubricated,  the  fecal  matter  slips  along  and 
easily  overcomes  mechanical  obstacles,  which  other- 
wise become  formidable  sources  of  obstruction. 

3.  The  human  alimentary  canal,  like  that  of 
other  primates,  as  illustrated  in  the  diet  of  the 
higher  apes,  is  adapted  to  a  moderately  coarse  bill 
of  fare.  The  concentrated  diet  of  our  modem 
civilized  life  contains  so  little  indigestible  material 
that  the  residue  forms  a  pasty  mass  which  tends  to 
adhere  to  the  intestinal  wall,  especially  when  any 
obstruction   is  presented   by  kinks,   folds,    adhesive 


BATHS  AND  OTHER  HOME  TREATMENTS   263 

bands,  or  a  spastic  state  of  the  bowel  due  to  colitis. 
When  delay  occurs,  the  further  absorption  of  water 
converts  these  pasty  residues  into  hard  masses,  scy- 
bala,  which  sometimes  have  almost  the  density  of 
wood.  Fats  of  all  sorts  are  more  or  less  laxative 
if  taken  in  sufficient  amount,  through  their  effect 
in  modifying  the  character  of  the  food  residues. 
They  render  the  mass  less  adhesive  and  to  some 
extent  prevent  dryness;  but  both  animal  and  vege- 
table fats  are  digestible  and  absorbable,  and  hence 
are  not  to  any  considerable  degree  effective  in  chang- 
ing the  character  of  the  stools  unless  eaten  in 
amounts  larger  than  can  be  used,  so  that  a  consider- 
able portion  remains  behind  in  the  colon.  Such 
large  quantities  of  fat  encourage  putrefaction,  lessen 
appetite,  diminish  the  secretion  of  hydrochloric  acid, 
interfere  with  the  motility  of  the  stomach  and  the 
small  intestine,  and  may  produce  great  disturbance 
of  the  body  metabolism.  Paraffin  oil  is  free  from 
these  objections,  since  it  is  wholly  non-absorbable, 
and  a  comparatively  small  amount  serves  the  pur- 
pose required,  because  it  all  remains  in  the  intes- 
tine. 

4.  Paraffin  is  useful  in  all  forms  of  intestinal 
stasis  or  stagnation,  no  matter  what  the  cause,  by 
preventing  the  abnormal  drying  out  of  the  food 
residue  which  is  the  necessary  result  of  too  long 
retention  in  contact  with  absorbing  surfaces. 

5.  Another  remarkably  interesting  and  useful 
property  of  paraffin  oil  is  found  in  the  fact  that  it 


264  COLON  HYGIENE 

stimulates  activity  of  the  small  intestine.  Observa- 
tions, in  a  large  number  of  cases,  made  by  Dr.  J. 
T.  Case,  Roentgenologist  at  the  Battle  Creek  Sani- 
tarium, have  shown  that  paraffin  oil  greatly  ac- 
celerates the  passage  of  material  through  the  small 
as  well  as  the  large  intestine.  This  action  is  ex- 
ceedingly important  in  those  forms  of  intestinal 
toxemia  which  depend  upon  iliac  stasis,  by  far  the 
most  serious  of  all  forms  of  stasis.  Stagnation  in 
the  small  intestine  is  of  far  greater  importance  than 
stasis  in  the  colon,  for  the  reason  that  both  putre- 
faction and  absorption  are  much  more  active  in 
this  part  of  the  digestive  tube  than  in  the  large  in- 
testine. Even  in  cases  in  which  iliac  stasis  is  due  to 
the  so-called  Lane's  kink,  as  shown  by  X-ray  ex- 
amination, great  relief  may  usually  be  obtained  by 
the  regular  use  of  paraffin.  This  has  been  demon- 
strated in  many  cases.  It  is  only  in  the  most  ex- 
treme cases,  when  adhesions  are  so  extensive  that 
the  lumen  of  the  intestine  is  very  greatly  reduced, 
that  surgical  measures  become  necessary. 

6.  One  of  the  most  interesting  features  of  the 
many-sided  useful  activities  of  paraffin,  is  its  be- 
havior toward  intestinal  toxins.  These  toxins  con- 
sist, not  only  of  bile  acids  and  alkaline  wastes  of 
various  sorts  excreted  by  the  intestinal  mucous 
membrane,  but  in  addition,  of  a  great  variety  of 
ptomaines  and  toxins  produced  through  bacterial 
action,  especially  in  the  colon,  and  also  in  the  small 
intestine  in  cases  of  incompetency  of  the  ileocecal 


BATHS  AND  OTHER  HOME  TREATMENTS  265 

valve.  Paraflfin  is  a  highly  active  solvent,  and 
readily  dissolves  these  waste  and  poisonous  sub- 
stances, many  of  which  are  more  soluble  in  paraffin 
oil  than  in  water.  The  result  is  that  the  paraffin 
oil,  itself  not  absorbable,  takes  up  a  very  consider- 
able portion  of  toxins  found  present  in  the  intestinal 
tract,  and  thus  prevents  their  absorption.  When 
paraffin  is  used,  it  may  always  be  seen  in  the  stools, 
showing  a  brov/nish  or  blackish  color,  due  to  the 
substances  which  it  holds  in  solution.  In  a  labor- 
atory test  made  by  a  competent  chemist  by  request 
of  the  writer,  it  was  found  that  when  paraffin  oil 
was  shaken  with  a  watery  solution  of  indol,  more 
than  half  the  indol  was  quickly  taken  up  by  the 
paraffin.  The  use  of  paraffin  thus  aSords  an  ef- 
fective means  of  hindering  the  absorption  of  in- 
testinal toxins,  and  conveying  them  out  of  the  body. 

7.  Paraffin  oil  serves  a  useful  purpose  in  pro- 
tecting the  mucous  membrane  when  it  is  in  an  ir- 
ritated state,  as  in  cases  of  chronic  colitis.  The 
value  of  petrolatum  and  other  neutral  petroleum 
products  as  a  dressing  for  wounds  is  well  known. 
Paraffin  acts  in  an  equally  favorable  way  upon 
irritated  mucous  surfaces.  It  has  long  been  used 
for  this  purpose  in  the  treatm.ent  of  diseases  of  the 
nose  and  throat. 

8.  Paraffin  serves  another  useful  protective  pur- 
pose in  hindering  the  absorption  of  poisons  by 
mucous  surfaces  which  have  been  deprived  of  their 
epithelium.     The  normal  epithelial  covering  of  the 


266  COLON  HYGIENE 

intestines  has  remarkable  filtering  powers,  by  which 
toxins,  especially  colloid  poisons,  are  excluded. 

This  filtering  power  is  lost  when  the  surface  is 
denuded.  A  protective  layer  of  oil  renders  great 
service  in  such  cases,  by  hindering  the  absorption 
of  these  poisonous  matters,  which  occurs  with  great 
readiness  through  abraded  surfaces. 

9.  In  cases  of  colitis,  parafnn  oil  protects  the 
irritated  surfaces,  but  also  through  its  lubricating 
effect  and  through  softening  the  intestinal  contents, 
aids  greatly  in  overcoming  the  spastic  condition  of 
the  intestine,  which  in  many  cases  of  chronic  con- 
stipation is  so  formidable  an  obstacle  to  recovery. 
Laxatives  of  all  sorts  increase  the  spasticity  of  the 
intestine,  and  so  aggravate  the  constipation  which 
they  are  given  to  relieve.  This  is  one  reason  why 
many  are  more  constipated  after  taking  a  laxative 
than  before.  Temporary  relief  is  obtained  by  the 
production  of  watery  stools  which  are  able  to  pass 
through  the  contracted  bowel,  but  as  soon  as  the 
first  effects  of  the  laxative  pass  off,  constipation  be- 
comes worse  than  before,  since  the  spasm  is  greater. 
Paraffin  lubricates  and  protects  the  sensitive  sur- 
face of  the  spastic  bowel,  and  at  the  same  time 
softens  the  intestinal  contents  so  as  to  permit  pas- 
sage through  the  bowel  without  mechanical  irrita- 
tion. Cases  of  colitis  are  greatly  benefited  by  the 
regular  use  of  paraffin. 

10.  X-ray  observations  of  Case,  confirmed  in 
many  cases  at  the  operating  table  by  the  writer, 


BATHS  AND  OTHER  HOME  TREATMENTS   267 

have  shown  that  incompetency  of  the  ileocecal 
valve  is  a  most  common  and  effective  cause  of  iliac 
stasis.  Experience  in  treating  several  hundreds  of 
cases  have  shov^^n  that,  aside  from  the  regulation 
of  diet,  and  the  use  of  bran  and  agar-agar,  the 
regular  use  of  paraffin  oil  is  the  most  effective 
means  of  combating  this  condition.  Medicinal 
laxatives  increase  the  antiperistalsis  by  w^hich  the 
reflux  from  the  colon  into  the  small  intestine  is 
increased.  Case  has  shown  by  X-ray  examination 
that  paraffin  increases  the  motility  of  the  small  in- 
testine, while  it  does  not  increase  antiperistalsis.  It 
is  thus  a  rational  and  efficient  remedy  of  great  value 
in  dealing  with  this  very  large  and  important  class 
of  cases. 

11.  In  all  cases  in  which  the  stagnation  of  the 
small  intestine  is  due  to  spasm  of  the  ileocecal  valve, 
induced  by  chronic  appendicitis,  ovarian  irritation 
or  inflammation,  colitis,  or  possibly  painful  rectal 
disease  through  reflex  irritation,  paraffin  proves  it- 
self to  be  an  invaluable  remedy,  since  it  has  the 
property  of  increasing  the  peristaltic  activity  of  the 
small  intestine  to  such  a  degree  as  to  enable  it  to 
overcome  the  spasm  of  the  ileocecal  valve  without 
producing  irritation,  which  would  inevitably  in- 
crease the  spasm  of  the  sphincter,  as  do  drug  laxa- 
tives. The  neutral  character  of  paraffin,  which 
enables  it  to  stimulate  and  facilitate  intestinal  mo- 
tility without  producing  irritation,  is  invaluable. 

12.  The  regular  use  of  paraffin  oil  very  generally 


268  COLON  HYGIENE 

relieves  hemorrhoids  and  fissure,  even  when  of 
some  years'  standing.  These  morbid  conditions 
are  usually  the  result  of  constipation,  and  are  main- 
tained and  aggravated  by  straining  at  stool.  By  the 
habitual  use  of  paraffin,  the  stools  are  made  soft, 
straining  is  avoided,  the  intestinal  contents  are  ren- 
dered less  irritating  and  infectious,  and  thus  the 
diseased  tissues  are  readily  healed. 

Since  adopting  the  use  of  paraffin,  the  author  has 
found  that  the  number  of  cases  in  vv^hich  operatioa 
for  hemorrhoids  is  needed  is  greatly  reduced.  Pa- 
tients v^^ho  have  contemplated  submitting  to  opera- 
tion for  removal  of  hemorrhoids  of  many  years' 
standing,  in  a  short  time  after  beginning  the  use 
of  paraffin,  often  find  themselves  so  completely  re- 
lieved  that  an  operation  is  no  longer  necessary.. 

13.  Paraffin  is  capable  of  rendering  invaluable 
service  in  cases  of  intestinal  intoxication,  by  increase 
ing  the  number  of  daily  stools.  The  length  of 
time  vi^hich  foodstuffs  remain  in  the  intestine  is 
reduced  from  several  days  to  a  few  hours.  This 
greatly  lessens  the  opportunity  for  development 
of  putrefactive  processes  and  the  absorption  of 
putrefaction  products.  It  may  be  justly  said  that 
no  other  remedy  is  capable  of  rendering  such  im- 
portant and  efficient  service  in  combating  constipa-- 
tion  as  this  simple  and  harmless  agent;  but  it  must 
be  continuously,  a  proper  dose  (one  or  two  table-^ 
spoonfuls)    at  each  meal. 


BATHS  AND  OTHER  HOME  TREATMENTS   269 

Objectionable  Features  of  Paraffin 

The  few  unpleasant  effects  attending  the  use  of 
paraffin  are  really  so  slight  in  character  that  they 
are  generally  easily  overcome.  Sometimes,  how- 
ever, they  constitute  a  real  obstacle  to  the  use  of  this 
most  valuable  remedy.  The  chief  objections  which 
are  met  are  the  fallowing: 

1.  An  unpleasant  oily  taste  which  to  some  peo- 
ple is  so  disagreeable  as  to  produce  nausea  and  loss 
of  appetite, 

2.  A  disposition  to  separate  from  the  other  intes- 
tinal contents.  It  usually  appears  as  a  brown  oily 
liquid  separated  from  the  rest  of  the  stool  and 
sometimes  the  separation  is  so  marked  that  the  stools 
are  very  ragged,  or  consist  of  hard  lumps  smeared 
with  brown  oil. 

3.  Paraffin  oil  is  so  limpid  that  it  readily  finds 
its  way  to  the  rectum  ahead  of  the  other  bowel 
contents,  and  very  easily  escapes,  either  with  or 
without  the  expulsion  of  flatus.  The  patient  is  often 
unconscious  of  the  escape  until  it  is  noted  that  the 
clothing  is  badly  soiled. 

The  difficulty  of  taking  paraffin  the  v/riter  suc- 
ceeded in  overcoming  almost  entirely  by  preparing 
a  very  hea-^/y  emulsion  through  the  assistance  of  g-um 
acacia.  This  emulsion  is  easily  taken  in  hot  or  cold 
weather,  but  is  open  to  the  objections  raised  under 
two  and  three. 


270  COLON  HYGIENE 

ParafSn  Tablets 

All  objections  are  removed  by  the  use  of  paraffin 
in  solid  form.  Paraffin  tablets  which  are  solid  at  or- 
nary  temperatures,  but  melt  at  the  temperature  of 
the  inside  of  the  body,  are  easily  taken  with  the 
food.  Paraffin  in  this  form  mixes  with  the  feces 
thoroughly  and  does  not  separate.  A  single  tablet 
(one-half  ounce)  is  sufficient  for  a  dose.  One  tab- 
let is  taken  with  each  meal.  Two  or  more  tablets 
may  be  taken  without  Injury. 

Lubrication  of  the  Rectum 

In  many  cases  of  chronic  constipation  the  lower 
colon  and  the  rectum  become  dry,  the  result  of 
atrophy  of  the  lubricating  mucous  glands  which 
have  been  destroyed  by  colitis  or  chronic  proctitis. 
This  condition  may  extend  up  into  the  pelvic  colon. 
As  a  result,  the  feces  adhere  to  the  walls  of  the 
bowel  and  so  accumulate,  forming  impactions  and 
cumulative  constipation,  one  of  the  most  frequent 
forms  of  constipation.  In  m.any  such  cases  only 
partial  relief  is  obtained  by  a  laxative  diet.  By  the 
use  of  paraffin  oil,  one  or  two  tablespoonfuls  before 
each  meal,  the  colon  and  rectum  may  be  lubricated 
artificially.  In  some  cases,  further  lubrication  is 
needed.  For  this  purpose  there  Is  nothing  so  useful 
as  a  specially  prepared  paraffin  which  melts  at  a 
temperature  of  102°  F.,  or  just  above  the  body 
temperature.     This  is  heated  until  it  is  nearly  all 


BATHS  AND  OTHER  HOME  TREATMENTS    271 

melted,  by  placing  the  container  In  hot  water.  Then 
with  a  piston  syringe  three  or  four  ounces  of  the 
warm  melted  paraffin  is  introduced  into  the  rectum. 

To  enable  the  paraffin  to  reach  the  pelvic  colon 
the  patient  should  assume  the  knee  chest  position 
for  two  or  three  minutes  after  the  paraffin  is  intro- 
duced and  should  take  deep  breaths  to  encourage 
the  distribution  of  the  melted  oil. 

The  temperature  of  the  body  being  about  100° 
F.,  or  less  than  that  of  the  paraffin,  the  latter  will 
be  cooled  below  its  melting  point,  and  so  will  ac- 
quire the  consistency  of  a  soft  ointment  which  ad- 
heres to  the  surface  of  the  bowel,  and  serves  as  a 
most  efficient  lubricant. 


Exercises  Which  Combat 
Constipation 

The  exercises  that  are  of  the  greatest  value  in 
cases  of  constipation  are  those  which  bring  into 
strong  action  the  muscles  of  the  abdomen.  The 
abdominal  muscles  are  generally  weak  and  relaxed, 
and  the  intra-abdominal  pressure  is  consequently 
low. 

By  appropriate  exercises  the  weak  muscles  may 
be  strengthened;  the  intra-abdominal  pressure  may 
be  raised,  and  the  colon  may  be  thus  enabled  to 
contract  with  sufficient  impetus  to  expel,  its  con- 
tents. 

Hill  Clijsibmg 

Hill  climbing  is  a  more  valuable  exercise  than 
walking  on  the  level,  because  the  abdominal  muscles 
are  brought  into  more  active  play.  When  moun- 
tain climbing  is  not  an  available  form  of  exercise, 
nearly  the  same  results  may  be  obtained  by  climb- 
ing a  ladder  or  by  walking  up  and  down  stairs. 
The  writer  has  also  made  use  of  the  treadmill  as 
the  means  of  securing  muscular  exercise  similar  to 
that  required  in  hill  climbing. 

272 


EXERCISES    FOR    CONSTIPATION         273 

Horseback  Riding 

Horseback  exercise  is  especially  indicated  as  an 
exercise  for  constipation.  Riding  a  considerable 
distance,  however,  is  necessary  to  produce  any  de- 
cided effect,  as,  on  the  whole,  horseback  riding  to 
a  person  accustomed  to  it,  is  not  very  active  exer- 
cise, except  when  riding  a  hard  trotting  horse. 

Rowing 

Rowing  is  one  of  the  very  best  exercises  to  com- 
bat constipation,  provided  the  chest  is  held  high 
during  the  exercise,  and  especially  if  care  is  taken 
to  give  the  trunk  as  strong  a  backward  movement 
as  possible;  but  care  must  be  taken  to  avoid  holding 
the  trunk  forward  with  the  shoulders  rounded  and 
the  chest  depressed. 

Tennis 

Tennis  may  be  highly  commended  for  young 
persons  and  those  who  are  sufficiently  strong  to 
engage  in  this  form  of  exercise  without  injury. 
This  very  popular  game  is,  however,  too  vigorous 
for  persons  with  weak  hearts. 

The  Medicine  Ball 

This  is  a  capital  exercise  for  persons  who  are 
fairly  strong.  It  brings  the  muscles  of  the  trunk 
into  vigorous  action. 


274  COLON  HYGIENE 

Work  Exercise 

The  movements  of  chopping  and  digging,  swing- 
ing the  hammer  and  mowing  are  highly  valuable 
exercises  if  taken  with  due  care  to  maintain  the 
body  in  an  erect  position.  Many  household  occu- 
pations, such  as  scrubbing,  washing,  and  general 
housework,  are  execellent  forms  of  exercise  when 
correct  posture  is  maintained. 

Posture 

Of  first  importance  to  persons  suffering  from 
constipation  is  the  maintenance  of  an  erect  position 
of  the  trunk.  When  the  chest  is  lowered,  as  in 
sitting  in  a  relaxed  attitude,  the  distance  between 
the  breast  bone  and  pelvis  is  diminished  so  that  the 
large  muscles,  which  form  the  front  of  abdominal 
wall  are  shortened  and  relaxed.  In  this  attitude 
the  muscles  cannot  be  contracted  sufficiently  to  pro- 
duce the  proper  degree  of  intra-abdominal  pressure. 
When  the  chest  is  held  high,  the  rectus  muscles  are 
stretched  and  are  thus  able  by  contraction  to  pro- 
duce the  maximum  effect  in  compressing  the  colon. 
Flat-chested  persons  are  predisposed  to  constipation 
because  of  inefficient  action  of  the  abdominal 
muscles. 

The  ordinary  chair  must  be  regarded  to  a  very 
considerable  degree  as  responsible  for  the  prevalence 
of  flat  chest  and  round  shoulders,  and  the  evils 
which  result  from  this  deformity.     It  is  possible  to 


Incorrect    Standing    Position 


Getting      Correct      Standing 
Posture    (First    Position). 


Method  of  Getting  Correct 
Standing  Posture  (Second  Po- 
sition)- 


Getting      Correct      Standing        Correct       Standing       Posture 
Posture    (Third   Position) 


EXERCISES    FOR    CONSTIPATION         275 

sit  in  an  erect  attitude  in  a  chair  of  any  shape;  but 
with  a  chair  with  a  straight  back,  constant  effort  is 
required,  by  forcible  contraction  of  the  muscles,  to 
maintain  the  body  in  an  erect  position.  The  moment 
the  muscles  are  permitted  to  relax,  the  trunk  falls 
into  an  abnormal  and  unhealthy  attitude,  the  spinal 
column  being  curved  backward  instead  of  forward, 
as  is  natural  and  necessary  for  health.  This  will 
readily  be  understood  by  reference  to  the  accompany- 
ing cuts. 

As  the  result  of  an  habitually  wrong  attitude  in 
sitting,  the  same  improper  attitude  is  maintained 
when  standing  and  walking,  and  the  figure  becomes 
deformed.  A  flat  chest,  round  shoulders,  and  a 
forward  carriage  of  the  hips  are  characteristics  to 
be  found  in  the  great  majority  of  persons  who  lead 
sedentary  lives,  especially  those  who  sit  much  at 
their  work,  such  as  accountants,  writers,  teachers, 
and  professional  people  generally.  One  of  the  first 
things,  then,  for  a  constipated  person  to  do  is  to 
correct  his  sitting  and  standing  attitudes.  This 
may  be  done  by  careful  execution  of  the  following 
exercises,  which  the  writer  has  employed  for  more 
than  25  years  with  much  satisfaction  in  the  treat- 
ment of  cases  of  this  sort. 

To  Correct  the  Standing  Posture 

Stand  against  a  straight  wall.  Place  heels,  hips, 
shoulders,  head  and  hands  firmly  against  the  wall. 


276  COLON  HYGIENE 

Now  bend  the  head  backward  as  far  as  possible, 
or  until  the  eyes  look  straight  up  to  the  ceiling,  at 
the  same  time  permitting  the  chest  and  shoulders 
to  move  forward.  While  holding  the  head  in  this 
position,  press  the  hands  firmly  against  the  wall; 
draw  the  chin  down  to  position  without  allowing 
the  shoulders  to  move  backward ;  still  holding  the 
body  rigid,  allowing  the  arms  to  fall  at  the  sides. 
In  this  position  the  chest  will  be  held  high  and  the 
abdominal  muscles  well  drawn  in.  While  holding 
this  position  execute  movements  with  the  arms ; 
arm  raising  above  the  head,  swimming  movements, 
etc. 

This  is  the  correct  standing  position  and  should 
as  far  as  possible,  be  constantly  maintained  in  stand- 
ing and  walking.  It  is  impossible,  of  course,  to 
hold  the  muscles  constantly  rigid.  In  relaxing, 
hov/ever,  care  should  be  taken  to  keep  the  chest 
forward,  so  that  the  body  does  not  fall  back  into 
the  former  incorrect  attitude. 

Exercises  to  Correct  the  Sitting  Posture 

Sitting  upon  a  chair  or  stool,  preferably  the  latter, 
proceed  as  follows: 

Place  the  hands  on  the  hips,  with  the  thumbs 
behind.  Bend  the  head  backward  so  as  to  look 
straight  up  to  the  ceiling;  now  bend  forward  as  far 
as  possible  while  still  keeping  the  eyes-on  the  ceiling; 
now  make  firm  pressure  with  the  thumrbs,  and  while 


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EXERCISES    FOR    CONSTIPATION         277 

pressing  hard  bring  the  body  up  to  the  erect  position. 
Still  keeping  the  eyes  upon  the  ceiling,  holding  the 
elbows  as  far  back  as  possible,  and  without  for  an 
instant  lessening  the  pressure  on  the  thumbs,  bring 
the  chin  down  to  position. 

If  this  movement  is  executed  according  to  direc- 
tion, it  will  bring  the  body  into  perfect  position, 
with  the  chest  raised  high  and  the  abdominal  mus- 
cles well  drawn  in,  as  shown  in  the  accompanying 
cut.  To  secure  definite  and  beneficial  results  it  is 
necessary  to  use  a  chair  having  a  back  of  the  right 
^ape  as  shown   in   the  accompanying  illustration. 

Breathing  Exercise 

Sit  with  the  hands  at  the  back  of  the  neck,  and 
the  elbows  in  line  with  the  shoulders,  the  chest 
held  high,  and  the  abdominal  muscles  well  drawn 
in.  Raise  the  heels  and  make  rapid  movements 
upon  the  floor  with  the  toes  for  one  minute.  Then 
take  ten  deep  breaths,  still  holding  the  arms  in  posi- 
tion. 

Rocking  Chair  Exercise 

Sitting  upon  the  front  edge  of  a  chair,  with  the 
hands  upon  the  hips,  the  thumbs  behind,  the  elbows 
well  drawn  back,  bend  forward  to  an  angle  of  45" 
and  then,  holding  the  body  rigid,  throw  the  trunk 
backward,  lifting  the  feet  clear  of  the  floor.  Repeat. 
Tlie  effect  will  be  a  rocking  movement.     Breathe 


278  COLON  HYGIENE 

deeply.     Repeat  forty  times.     A  rocking  chair  may 
be  conveniently  used  in  taking  this  exercise. 

Exercise  to  Raise  the  Chest 

Lie  upon  the  back  on  a  hard  surface;  place  be- 
neath the  hollow  of  the  back  a  roll  of  blankets  or 
a  folded  pillow  or  cushion  about  six  inches  in 
diameter.  The  purpose  of  this  is  to  give  the  spinal 
column  the  forward  curve  which  is  natural  to  it, 
and  thus  to  raise  the  chest.  The  roll  should  be 
placed  at  such  a  point  as  to  raise  the  chest  to  the 
fullest  extent,  while  the  head  and  shoulders  still 
rest  upon  the  couch.  In  this  position,  deep  breath- 
ing movements  should  be  practiced  at  the  rate  of 
about  ten  a  minute. 

To   Strengthen   the   Abdominal   Muscles 

With  the  back  supported  as  in  the  previous 
paragraph,  raise  both  legs  to  the  perpendicular. 
Repeat  ten  to  forty  times.  A  deep  breath  should 
he  taken  just  before  the  legs  are  raised,  and  after 
each  movement  there  should  be  a  pause  during 
which  a  deep  breath  is  taken. 

Feeble  and  very  fleshy  persons  are  -often  at  first 
not  able  to  raise  the  legs.  In  such  cases  the  exer- 
cise will  begin  with  the  legs  drawn  up  to  a  fixed 
position.  By  extending  the  legs  and  allowing  them 
at  the  same  time  to  drop  slowly  to  the  starting 
position,   the   abdominal  muscles  may  be    brought 


EXERCISES    FOR    CONSTIPATION         279 

into  strong  contraction,  and  as  they  gradually  in- 
crease in  strength,  the  legs  may  be  flexed  less  until 
they  can  be  raised  to  a  vertical  position  without 
flexion. 

Trunk   Raising    Exercise 

Lying  on  the  back  and  holding  the  legs  firmly 
extended,  raise  the  arms  fonvard  and  raise  the  body 
to  the  perpendicular,  then  bend  forward,  and,  if 
possible,  touch  the  toes.  Repeat  ten  to  twenty 
times. 

Rolling  Exercise 

Rolling  over  on  the  floor  or  on  a  wide  bed  is  a 
capital  exercise  for  strengthening  the  lateral  muscles 
of  the  trunk.     Practice  for  five  minutes. 

Rocking  Exercise,  Lying 

Flex  the  left  leg  upon  the  abdomen;  clasp  the 
hands  beneath  the  knee  and  pull  as  hard  as  pos- 
sible, so  as  to  force  the  thigh  down  upon  the  ab- 
domen; then,  with  the  other  leg  fully  extended, 
cause  the  body  to  execute  rocking  movements  by 
quickly  moving  the  leg  up  and  down,  assisting  by 
forward  and  backward  movements  of  the  head. 
Repeat  same  with  the  right  leg.  This  is  a  very  ef- 
fective exercise  if  taken  vigorously  and  repeated 
three  times  a  day  for  five  or  ten  minutes. 


280  COLON  HYGIENE 

Arm  and  Trunk  Exercise  with  Deep 
Breathing 

Standing  with  the  chest  held  high,  place  left  hand 
upon  the  left  hip.  With  a  swinging  movement 
outward  bring  the  right  arm  to  the  perpendicular, 
and  then  holding  the  arm  in  position,  bend  the 
body  to  the  left  side  as  far  as  possible,  breathing 
in.  Rise  to  position,  breathing  out.  Repeat  four 
times  and  then  execute  the  same  movement  with 
the  right  hand  upon  the  hip,  breathing  in. 

Squatting  Exercise 

Standing,  v/ith  the  heels  separated  ten  or  twelve 
inches,  the  hands  upon  the  hips,  execute  squatting 
movements,  bringing  the  trunk  as  near  to  the  floor 
as  possible,  and  bending  slightly  forward.  An 
excellent   exercise  to   stimulate  bowel  movement. 

Running  on  All  Fours 

With  arms  and  legs  extended  run  about  the 
room  for  five  or  ten  minutes.  Running  on  all  fours. 
This  movement  was  prescribed  by  a  Berlin  physician 
for  an  eminent  German  Statesman,  with  excellent 
results. 

Knee-Chest  Breathing 

Placing  the  body  in  the  knee-chest  position,  ex- 
ecute deep  breathing  movements,  filling  the  chest 


EXERCISES    FOR    CONSTIPATION  281 

as  completely  as  possible,  then,  holding  the  chest 
in  position,  draw  in  the  abdomen  as  much  as  pos- 
sible while  breathing  out. 

Colon  Compressing  Exercise 

Sitting  on  a  low  seat  or  with  the  feet  raised  upon 
a  stool,  place  the  closed  fists  in  the  left  groin  and 
bend  the  trunk  strongly  foi^vard  so  as  to  com- 
press the  hands  between  the  thighs  and  the  abdo- 
men. Take  several  deep  breaths  while  holding  the 
body  in  this  position. 

Inclined  Plane  Exercises 

Among  the  most  important  of  all  forms  of  ex- 
ercises for  combating  constipation,  series  of  certain 
simple  exercises  are  taken  upon  an  inclined  plane, 
with  the  head  low.  The  special  advantages  of  the 
inclined  plane   are: 

1.  The  head-low,  hips-high  position  greatly 
aids  in  the  replacement  of  the  prolapsed  stomach 
and  colon,  conditions  almost  universally  present 
in  chronic  constipation. 

2.  The  head-low  position  drains  the  abdomen 
of  blood,  thus  relieving  congestion  of  the  viscera, 

3.  Exercises  of  the  trunk  muscles  should  always 
be  taken  after  the  prolapsed  viscera  have  been  re- 
stored  to  position.  When  this  is  not  done,  the  ef- 
fect may  be  to  increase  the  displacement  whenever 
the  abdominal  muscles   are  strongly  contracted. 


282  COLON  HYGIENE 

There  are  three  classes  of  exercises  to  be  taken 
with  the  inclined  plane,  viz :  ( 1 )  Stretching  ex-« 
ercises,  (2)  Colon  replacing  exercises,  and  (3) 
Trunk  exercises. 

The  folding  exercise  table  is  a  convenient  ap' 
pHance  for  use  in  these  exercises.  It  may  be  in 
part  replaced  by  an  ordinary  ironing  board  placed 
with  one  end  resting  upon  the  side  of  a  bed,  couch 
or  window  sill,  the  other  on  the  floor.  The  ex- 
ercise table  is  provided  with  a  strap  at  one  end 
to  hold  the  feet  and  prevent  slipping  down  and  a 
rope  with  handle  attached  for  pulling  the  body 
up.  At  the  sides  are  placed  handles  to  be  grasped 
by  the  patient. 

Getting  in  Position 

The  following  is  a  convenient  method  of  plac- 
ing one's  self  in  position  upon  the  table:  Standing 
upon  the  left  side  of  the  table  grasp  the  strap  with 
the  right  hand.  Sit  down  upon  the  table  and 
swing  up  one  foot  and  place  it  under  the  strap 
and  then  bring  up  the  other  foot  in  the  same  way 
and  then  grasp  the  sides  of  the  table  or  the  handles 
and  let  the  trunk  fall  down  into  position.  While 
an  ordinary  ironing  table  may  be  used,  the  strap  for 
the  feet  and  the  handles  for  the  hands  are  really 
essential  for  convenient  use. 

After  getting  into  position  upon  the  table,  the 
patient  takes  a  few  very  deep  breaths,  holding  the 
chest  high  while  breathing  out. 


The  Exercise   Table 


EXERCISES    FOR    CONSTIPATION         283 

Exercises 

Grasping  the  handles,  bend  the  head  backward 
as  far  as  possible,  at  the  same  time  widely  opening 
the  mouth  as  in  yawning. 

Position 

Patient  lies  upon  an  inclined  table  grasping  the 
handles.  (a)  Right  arm,  left  leg  stretch.  (b) 
Grasping  handle  with  left  hand  raise  the  right  arm 
above  the  head  and  at  the  same  time  point  the  toe 
of  the  left  foot  and  reach  as  far  as  possible  in  oppo- 
site directions,  (c)  Do  the  same  with  the  left  arm 
and  right  leg. 

Colon  Replacing  Exercises 

Lying  on  the  inclined  table  with  feet  under  the 
strap,  place  the  hands  upon  the  lower  abdomen  and 
breathe  deeply;  with  each  expiration  press  hard 
upon  the  little-finger  side  of  the  hands  and  draw 
the  hand  upward  so  as  to  push  the  contents  of 
the  abdomen  toward  the  diaphragm.  Hold  the 
hands  firmly  in  position  during  the  inspiration. 
JR.epeat  ten  or  twelve  times. 

Abdominal  Compression-Breathing 

Compress  the  abdomen  firmly  with  the  hands 
and  take  a  slow  deep  breath.  Repeat  fifteen  or 
twenty  times. 


284  COLON  HYGIENE 

Diaphragm  Exercise 

Lie  upon  the  face  over  a  folded  pillow  or 
cushion  with  the  feet  under  the  strap  and  the  head 
resting  upon  the  folded  arms.  Take  deep  breaths. 
This  is  an  exercise  for  relieving  congestion  of  the 
abdominal  viscera,  strengthening  the  breathing 
muscles.  At  each  breath  the  diaphragm  is  com- 
pelled to  lift  the  weight  of  the  trunk. 

Exaggerated  Knee-Chest  Breathing 

Grasping  the  handles,  rise  from  the  position  of 
the  preceding  exercise  to  a  kneeling  position,  push- 
ing the  pillow  forward  a  little  and  then  take  the 
knee-chest  position;  take  ten  to  fifty  deep  breaths. 
This  is  a  most  effective  means  of  draining  the  over- 
filled blood-vessels  of  the  abdomen  and  pelvis,  and 
sets  gravitation  to  work  pulling  the  prolapsed  or- 
gans into  position.  The  exercise  is  still  more  effec- 
tive if  taken  after  filling  the  colon  with  water,  as 
the  added  weight  of  the  prolapsed  organ  assists  in 
restoring  it  to  position. 

Leg  Raising 

Lying  on  the  back,  hands  grasping  the  handles, 
while  holding  both  legs  straight  and  toes  pointed, 
raise  them  to  vertical  position  while  counting  four, 
Lower  at  the  same  rate.     Repeat  eight  to  twelve 


EXERCISES    FOR    CONSTIPATION  285 

times,  taking  one  or  two  deep  breaths  after  each 
movement. 

Trmik  Twistissg 

Back  lying,  feet  under  strap,  throw  the  extended 
right  arm  over  to  the  left,  at  the  same  time  turning 
the  face  and  shoulders  in  the  same  direction.  Re- 
turn to  position,  and  repeat  eight  or  ten  times.  Do 
the  same  with  the  left  arm. 


Back  lying,  draw  the  knees  up  as  far  as  possible, 
then  extend  the  limbs  vigorously  as  far  as  pos- 
sible toward  the  left,  rolling  the  body  in  the  same 
direction.  When  the  legs  are  completely  extended, 
carry  them  straight  across  to  the  opposite  side,  roll- 
ing back  toward  the  right  side.  Complete  the 
movement  by  drawing  the  legs  back  to  the  flexed 
position  and  returning  to  the  starting  position. 
Repeat  ten  or  twelve  times,  pausing  long  enough 
after  each  movement  to  take  one  or  two  deep 
breaths.  This  is  a  most  excellent  exercise  for  all 
the  muscles  of  the  trunk. 

Static  Exercises 

These  are  exercises  which  may  be  taken  while 
one  is  engaged  in  study,  writing,  book-keeping,  or 
some  sedentary  occupation,  without  interfering 
with  the  work  in  hand.     The  purpose  being    to 


286  COLON  HYGIENE 

combat  the  pernicious  effects  of  any  form  of  con- 
fining work. 

With  the  chest  held  high,  the  abdominal  mus- 
cles well  drawn  in,  and  the  body  supported  in  a 
correct  posture,  deep  breathing  may  be  practiced 
with  most  excellent  results.  The  breathing  may 
often  be  made  rhythmical  with  the  work,  especially 
in  typewriting,  adding  and  similar  work  which  is 
more  or  less  mechanical  in  character.  In  this  way 
exercise  may  become  a  means  of  increasing  efficiency 
directly,  as  well  as  through  better  aeration  of  the 
blood  and  the  resulting  improvement  in  mental  and 
physical  activity. 

This  deep  breathing  may  be  practiced  under  al- 
most any  conditions  without  interfering  with  the 
work  in  hand.  When  riding  on  the  street  cars  or 
in  an  automobile,  even  when  sitting  in  church  or 
at  a  lecture,  deep  breathing  may  be  practiced  al- 
most continually.  The  practice  will  be  found  to 
promote  bowel  activity,  and  to  enormously  increase 
efficiency  and  endurance.  When  the  habit  is  once 
formed  the  deep  breathing  becomes  automatic. 
Typists,  printers,  and  persons  engaged  in  similarly 
unhealthful  occupations  may,  by  this  means  so 
strengthen  their  resistance,  and  maintain  such  a 
high  state  of  vital  efficiency,  that  they  may  possibly 
escape  the  dreaded  pulmonary  tuberculosis,  the 
malady  above  all  others  that  is  the  most  fatal  to 
this  class  of  workers. 


EXERCISES    FOR    CONSTIPATION         287 

Tension  Exercises 

During  life  the  muscles  are  always  in  a  state  of 
tension;  that  is,  every  muscle  is  more  or  less  active 
even  when  it  seems  to  be  at  rest.  This  tension  is 
increased  by  cold  to  the  point  of  producing  visible 
movements  of  shivering.  It  is  also  increased  by 
pain  or  inflammation,  as  is  seen  in  the  rigid  con- 
traction of  the  abdominal  muscles  in  appendicitis. 
Tension  may  also  be  increased  by  a  simple  effort 
of  the  will.  The  mere  thinking  of  a  bodily  move- 
ment, in  fact,  increases  the  tension  of  the  muscles 
which  are  concerned  in  the  movement,  and  to  such 
a  degree  that  long-continued  fatigue  may  result, 
showing  that  work  has  been  done,  as  when  one 
watches  the  performance  of  acrobats,  or  a  closely 
contested  athletic  game.  This  fact  may  be  made 
of  practical  value.  Thus  if  one's  feet  are  cold,  they 
may  be  quickly  warmed  by  alternately  tensing  and 
lelaxing  the  muscles  of  the  legs,  or  by  making  slow, 
tense,  flexion  and  extension  movements  of  the  feet. 

In  like  manner  all  the  muscles  of  the  legs  may 
be  brought  into  active  play  by  simply  setting  or 
tensing  the  muscles  of  the  legs  that  is,  holding  the 
limbs  rigid  with  as  much  force  as  possible.  The 
muscles  of  the  trunk  and  arms  may  be  tensed  in 
like  manner.  All  the  muscles  may  be  tensed  at 
once,  or  different  sections  as  arm  muscles,  trunk 
muscles,  or  the  muscles  of  a  single  limb  may  be 
exercised  in  succession.     Tension  exercises  may  be 


288  COLON  HYGIENE 

taken  in  may  cases  v.-ithout  tlie  slightest  interfer- 
ence with  one's  work;  and  when  the  work  is  very- 
sedentary  one  may  by  this  means,  without  loss  of 
time,  secure  a  large  part  of  the  benefit  of  such  ac- 
tive exercises  as  walking,  tennis,  playing,  etc.  Such 
exercises  should  not  be  considered  as  a  substitute, 
however,  for  out-of-door  exercise,  but  rather  as  a 
supplement  to  such  exercise. 

One  very  excellent  form  of  exercise  which  may 
be  taken  while  sitting  at  desk  at  work  or  when 
reading  or  studying  is  rapid  raising  or  lowering 
of  heels,  either  together  or  in  alternation.  The  heels 
are  raised  so  that  the  weight  of  the  limbs  rests  on 
the  toes,  and  the  limbs  are  then  set  in  rapid  mo- 
tion. Bracing  the  feet  together,  a  similar  move- 
ment may  be  executed  with  the  knees  rapidly  sepa- 
rating and  closing.  The  m.ovement  is  so  rapid  that 
the  exercise  closely  resembles  shivering. 

One  excellent  use  for  movements  of  this  kind 
is  to  prevent  taking  cold  when  one  is  exposed  to 
a  draft.  If,  for  example,  one  feels  a  draft  of  cold 
air  on  the  back  of  the  neck,  he  may  prevent  ill 
effects  by  simply  tensing  muscles  of  the  neck,  or 
indeed,  by  holding  the  muscles  rigid  while  making 
slow  movements  of  the  head,  either  forward  and 
backward  or  side-wise.  In  out-of-door  sleeping, 
exercises  of  this  sort  may  be  resorted  to  as  a  means 
of  warming  the  feet  and  limbs.  These  warming 
exercises  are  important  for  persons  suffering  from 
constipation,    because    of    the    tendency    that    such 


EXERCISES    FOR    CONSTIPATION  289 

persons  have  to  coldness  of  the  extremities,  the 
result  of  spasm  of  the  blood  vessels,  due  to  the 
influence  of  intestinal  poisons  upon  the  vasomotor 
centers. 

Special  Means  to  Aid  Defecation 

The  general  aim  of  all  the  exercises  given  in 
this  book  is  to  aid  defecation  by  strengthening  the 
muscles  of  the  trunk  and  abdomen,  and  forming  the 
breathing  movements.  There  are  special  exercises 
which  may  be  employed  during  defecation  w^hich 
render  effective  aid  in  evacuation  of  the  bowels. 

The  natives  of  India,  as  mentioned  elsewhere, 
aid  evacuation  when  the  bowels  are  constipated  by 
pressing  a  ball  formed  by  a  folded  cloth  upon  the 
lower  left  side  of  the  abdomen.  Many  consti- 
pated persons  have  found  by  experience  the  advan- 
tage of  pressing  upon  this  part  of  the  abdomen  with 
one  or  both  closed  fists,  during  defecation. 

Persons  who  have  very  relaxed  abdominal  walls 
often  find  it  very  advantageous  to  compress  and 
knead  the  abdomen  during  defecation,  especially 
upon  the  left  side.  A  medicine  ball  may  be  used 
for  the  purpose.  The  ball  is  held  firmly  against 
the  abdomen,  the  under  side  resting  on  the  separated 
thighs.  By  bringing  the  thighs  together  at  the 
same  time  pressing  with  the  hands,  the  ball  is  forced 
against  the  abdomen.  The  abdomen  may  in  this 
way  be  compressed  with  considerable  force.  The 
closed  fist  may  be  used  in  place  of  the  ball. 


290  COLON  HYGIENE 

An  Exercise  Program 

When  possible  exercise  should  always  be  taken 
in  a  rhythmical  way.  This  effect  may  be  secured 
by  means  of  counting,  or  better  still  by  the  aid  ef 
music,  for  which  a  phonograph,  victrola  or  a  graph- 
aphone  serves  an  excellent  purpose. 

The  following  is  an  excellent  program  of  ex- 
ercises for  a  person  of  average  strength: 

1.  On  rising,  take  an  exercise  bath  (see  page 
242),  beginning  with  the  water  at  a  temperature 
of  90  degrees  and  ending  at  70  degrees  to  60  degrees 
or  pipe  temperature.  Row  100  to  200  strokes 
counting. 

2.  Inclined  plane  breathing  and  replacement 
exercises.     (See  page  281.) 

3.  Inclined  plane  exercise  to  strengthen  ab- 
dominal muscles.     (See  page  282.) 

4.  Special  exercise  to  aid  defecation.  (See 
page  289.) 

After  exercise  make  an  attempt  to  move  the 
bowels  if  a  movement  has  not  already  been  se- 
cured. 

Abdominal  Massage 

Before  beginning  the  treatment  of  any  case  of 
constipation  by  massage,  a  careful  study  of  the 
case  should  be  made,  so  that  the  causes  of  the  con- 
dition present  may  be  well  understood.  Such  an 
examination  requires,  in  serious  cases,   at  least  an 


Kneading  the  Colon 


EXERCISES    FOR    CONSTIPATION         291 

Ti-ray  examination  with  a  bismuth  meal.  The  bis- 
muth enema  must  also  be  administered  to  show  the 
condition  of  the  colon  and  of  the  ileocecal  valve. 
A  radiogram  of  the  colon  or  at  least  a  tracing  made 
by  the  aid  of  the  X-ray,  showing  the  position,  size 
and  form  of  the  different  portions  of  the  colon  is 
of  greatest  service.  With  the  radiogram  and  such 
a  sketch  of  the  colon  at  hand,  the  masseur  can  make 
his  applications  with  such  a  degree  of  accuracy 
as  to  effect  a  maximum  amount  of  good  with  a 
minimum  degree  of  effort,  and  without  wearying 
his  patient  needlessly.  The  following  methods  of 
colon  massage  are  described  at  greater  length  in 
the  author's  work  on  massage.* 

Massage  of  the  Cecum 

In  cases  in  which  there  is  stagnation  of  the  fecal 
matters  in  the  cecum  and  ascending  colon,  massage 
should  be  applied,  with  the  patient's  hips  elevated 
to  an  angle  of  about  45°.  Deep  kneading  move- 
ments should  be  made  from  below  upwards,  work- 
ing along  the  colon  in  the  direction  of  the  lower 
ribs  of  the  right  side.  When  the  liver  is  reached, 
the  kneading  movements  should  be  carried  across 
the  body  in  the  direction  of  the  transverse  colon. 
The  hips  of  the  patient  should  then  be  lowered,  and 
the  kneading  movement  should  be  directed  down- 


*"The  Art  of  Massage."    Published  by  Good  Health  Pub.  Co 
Battle  Creek,  Michigan. 


292  COLON  HYGIENE 

ward  along  the  descending  colon,  starting  from 
high  up  on  the  ribs  of  the  left  side.  When  the  upper 
border  of  the  hip  bone  is  reached,  the  movement 
should  follow  the  inner  surface  of  the  bone  to  the 
pelvis.  Not  infrequently  the  colon  is  found  in  a 
contracted  or  spastic  state  when  it  feels  like  a  rub- 
ber tube  and  may  be  rolled  under  the  fingers.  It 
is  usually  sensitive  to  pressure.  When  the  pelvic 
colon  is  enlarged,  it  may  also  sometimes  be  felt, 
though  not  infrequently  when  it  is  distended  with 
feces  it  lies  so  low  in  the  pelvis  that  it  cannot  be 
reached.  By  putting  the  patient  in  a  knee-chest 
position,  and  executing  deep-breathing  movements 
while  making  deep  pressure  with  one  hand  on  each 
side  just  above  the  groins,  the  pelvic  colon  can 
sometimes  be  lifted  out  of  the  pelvis,  so  that  it  can 
be  brought  within  reach,  and  the  hard  miasses  with 
which  it  is  filled  may  be  broken  up.  In  this  region 
the  colon  will  often  be  found  filled  with  masses  of 
hardened   feces. 

After  careful  manipulation  of  the  contracted 
colon  for  a  few  minutes  it  will  dilate,  the  spastic 
condition  disappearing  for  the  time  being.  The 
writer  has  often  noticed  this  in  making  examina- 
tions of  the  colon.  Harsh  manipulations  are  likely 
to  produce  the  opposite  effect  increasing  the  spasm 
This  fact  has  led  some  authors  to  forbid  massage 
altogether  in  cases  of  colitis,  but  this  is  quite 
wrong.  Massage  is  highly  beneficial  In  these 
cases  but  the  manipulations  must  not  be  too  severe. 


Vibrating  Chair 


EXERCISES    FOR    CONSTIPATION  293 

Mechanical  Kneading  and  Vibration 

Mechanotherapy  is  capable  of  rendering  more 
service  in  constipation  than  in  any  other  single  con- 
dition. 

The  mechanical  applications  which  are  of 
greatest  service  are  kneading  and  vibration.  Sev- 
eral mechanical  kneaders  have  been  devised.  The 
one  shown  ip  the  accompanying  cut  the  writer  has 
had  in  use  for  more  than  twenty  years,  and  with 
satisfactory  results.  Patients  generally  realize  im- 
mediate benefit  from  the  use  of  the  kneader,  which 
may  be  employed  for  fifteen  or  twenty  minutes 
twice  a  day,  an  hour  after  breakfast,  and  an  hour 
or  two  after  dinner. 

The  apparatus  consists  of  six  kneading  arms  at- 
tached to  eccentrics,  arranged  in  such  a  way  as  to 
be  brought  to  bear  upon  the  abdomen  in  consecutive 
order.  The  surface  upon  v/hich  the  patient  rests 
is  at  the  same  time  moved  to  and  fro  in  such  a  way 
that  the  kneading  movement  travels  in  a  series  of 
circles  round  the  abdomen.  The  vigor  of  the  appli- 
cation can  be  regulated  at  will. 

There  are  vibrators  of  various  kinds  in  use.  The 
majority,  however,  are  possessed  of  too  little  power 
to  be  of  service  in  the  treatment  of  the  abdomen. 
The  best  for  this  purpose  are  the  dumb-bell  vibrator 
and  the  vibrating  chair.  Hill's  dumb-bell  vibrator 
has  the  advantage  that  it  is  heavy  enough  to  com- 
press the  abdomen  to  a  sufficient  degree;  and  the 


294  COLON  HYGIENE 

power  of  the  apparatus  is  sufficient  to  give  the 
whole  abdomen  an  active  vibratory  movement.  It 
has  been  proved  that  these  vibratory  movements 
induce  peristaltic  action,  while  at  the  same  time  the 
weight  of  the  instrument  increases  the  abdominal 
pressure,  and  tends  to  fix  the  parts  to  which  the 
application  is  made,  so  as  to  secure  a  maximum  de- 
gree of  effect. 

The  vibrating  chair  aids  bowel  action  both  by 
directly  exciting  the  centers  of  the  spinal  cord  and 
by  stimulating  the  lower  bowel.  The  use  of  the 
chair  for  ten  or  fifteen  minutes  will  in  many  persons 
develop  a  lively  "call"  for  bowel  movement. 

Self-Kneading  of  the  Bowels  at  Stool 

In  many  cases  of  cumulative  constipation  the 
chief  trouble  is  in  the  pelvic  colon.  This  loop  of 
intestine,  usually  about  a  foot  in  length,  and  possess- 
ing thick  muscular  walls,  becomes  sometimes  so 
enormously  stretched  and  attenuated  by  accumula- 
tions of  fecal  matters  and  gas  that  its  walls  are 
weak  and  contract  very  feebly,  and  it  is  no  longer 
an  efficient  instrument  for  forcing  the  feces  into 
the  rectum,  and  thus  inducing  the  defecating  reflex 
by  which  the  bowel  is  normalh^  emptied.  In  such 
a  case  the  patient  may  sometimes  assist  himself  by 
placing  the  hand  at  the  lower  part  of  the  abdomen 
on  the  left  side  and  making  deep  pressure  with  the 
tips  of  the  fingers,  or  placing  the  fist  between  the 


EXERCISES    FOR    CONSTIPATION  295 

thigh  and  the  abdomen  so  as  to  compress  the  pelvic 
colon.  Kneading  of  the  iliac  colon,  which  lies  in 
the  hollow  of  the  left  iliac  bone,  is  also  useful. 

The  Cannon  Ball 

The  cannon  ball  is  a  rather  old-fashioned  but 
useful  means  of  self  treatment,  by  which  the  pa- 
tient may  apply  massage  to  the  colon  in  a  very 
efficient  way.  A  small  cannon  ball  weighing  about 
twenty  or  twenty-five  pounds  is  rolled  along  the 
course  of  the  colon  from  the  cecum  toward  the 
rectum.  The  patient  should  lie  with  the  shoulders 
slightly  elevated  so  as  to  relax  the  abdominal  mus- 
cles as  much  as  possible. 

The  cannon  ball  should  be  applied  daily  soon 
after  breakfast,  or  a  little  before  the  time  at  which 
the  bowels  are  most  likely  to  move.  The  chief  ben^ 
efit  to  be  derived  from  the  cannon  ball  is  to  aid 
in  propelling  into  the  rectum  from  the  pelvic  colon 
a  sufficient  amount  of  fecal  matter  to  awaken  a 
lively  stimulation  of  the  defecating  center,  and  so 
to  secure  a  strong  impulse  and  a  full  evacuation  of 
the  colon  below  the  splenic  flexure. 

The  Weighted  Compress 

This  consists  of  a  thick  flannel  compress  between 
the  folds  of  which  is  quilted  in  a  considerable  quan- 
tity, say  fifteen  to  twenty-five  pounds,  of  lead  shot. 
The  compress  should  be  large  enough  to  cover  the 


296  COLON  HYGIENE 

entire  abdomen.  It  should  be  applied  for  an  hour 
before  time  for  evacuation  of  the  bowels,  deep 
breathing  movements  being  executed  in  the  mean- 
time at  the  rate  of  tvi^elve  to  sixteen  per  minute. 

The  Shot  Bag 

This  device  has  essentially  the  same  purpose  as 
the  preceding,  but  may  be  applied  in  such  a  way 
as  to  secure  a  more  pronounced  local  effect;  as,  for 
example,  to  force  stagnating  material  out  of  the 
cecum  or  the  iliac  colon.  It  may,  in  some  cases, 
also  be  of  service  in  forcing  feces  from  the  pelvic 
colon  into  the  rectum,  when  the  pelvic  loop  has 
been  weakened  by  excessive  overloading  and  dis- 
tention with  gas.  The  usual  weight  of  the  shot 
bag  is  twenty  to  twenty-five  pounds.  It  should 
be  placed  over  the  spot  where  the  accumulation 
can  be  felt  v^ith  the  fingers  or  seen  with  the  X-ray 
and  should  be  left  in  place  for  an  hour,  while  deep 
breathing  movements  are  practiced  at  the  rate  of 
twelve  to  sixteen  per  minute. 

This  simple  measure  has  the  advantage  that  it 
may  be  used  by  the  intelligent  patient  at  his  home, 
and  its  use  may  be  continued  for  an  indefinite  time 
without  injury,  which  cannot  be  said  of  any  drug 
remedy.  All  drugs  which  act  by  irritating  the  in- 
testine, sooner  or  later,  usually  sooner,  produce 
colitis  and  other  disorders.  There  are  no  harmless 
drugs.  Of  course  this  does  not  apply  to  such  purely 
mechanical  and  harmless  means,  as  bran  and  paraffin. 


Relaxed  protuberant  ab- 
domen, a  result  of  bad  sit- 
ting position. 


The  same  person  stand- 
ing, poise  corrected  and  ab- 
domen held  up  by  a  spring 
supporter. 


EXERCISES  FOR  CONSTIPATION  297 

Fneuznatic  Compression  of  the  Abdomen 

Compression  of  the  abdomen  by  an  inflated  rub- 
ber bag  is  a  measure  of  value,  of  which  the  writer 
has  made  use  for  some  years.  On  one  occasion, 
a  patient  who  seemed  dead  from  surgical  shock  was 
restored  almost  instantly  by  placing  a  rubber  bag 
under  an  abdominal  bandage  and  inflating  it  as 
fully  as  possible.  The  face,  which  had  become 
ashen  gray,  while  the  heart  had  ceased  to  beat,  at 
once  became  flushed  with  the  color  of  health,  the 
heart  began  to  beat,  the  patient  began  breathing, 
and  death  was  averted.  This  observation  showed 
the  effect  of  abdominal  compression  applied  in  this 
way,  and  suggested  the  use  of  the  same  means  to 
increase  the  intra-abdominal  tension  as  an  aid  to 
bowel  movement.  In  using  the  bag  for  this  pur- 
pose, it  must  be  tightly  compressed  by  means  of  a 
stout  bandage,  and  must  be  large  enough  to  cover 
the  whole  abdomen,  so  that  when  inflated  it  will 
well  fill  the  abdominal  cavity,  pressing  before  it 
the  relaxed  abdominal  wall. 

The  compression  bag  is  of  special  service  in  cases 
in  which  the  abdominal  muscles  are  very  greatly 
relaxed,  as  in  women  who  have  borne  a  number 
of  children,  and  whose  muscles  have  not  been  well 
developed.  It  is  most  applicable  to  those  who  have 
not  a  superabundance  of  fat,  especially  those  who 
have  lost  much  in  weight  after  having  been  over- 
fat. 


298  COLON  HYGIENE 

The  Abdominal  Supporter 

While  compression  of  the  trunk  at  the  waist  is 
always  harmful,  compression  and  support  of  the 
lower  abdomen  is  of  great  service  in  many  cases, 
because  of  the  unnatural  feebleness  of  the  abdom- 
inal muscles.  In  fleshy  patients  almost  any  sort 
of  bandage  will  accomplish  good,  but  in  thin  pa- 
tients an  ordinary  bandage  is  of  little  use,  for 
the  reason  that  it  is  held  out  in  front  by  edges  of 
the  iliac  bones,  and  so  does  not  press  with  sufficient 
firmness  upon  the  lower  abdomen  where  support  is 
needed. 

The  most  effective  support  in  such  cases  can  be 
secured  only  by  a  bandage  which  is  compressed  by 
springs.  Such  a  bandage,  which  the  writer  has 
had  in  use  for  more  than  a  dozen  years,  is  shown 
in  the  accompanying  cut.  In  fleshy  patients  a 
stout  bandage  made  of  ducking  and  cut  to  fit 
snugly  is  of  greatest  service. 

The  bandage  must  be  worn  constantly  when 
the  patient  is  on  his  feet.  Its  purpose  is  not  simply 
to  support  the  viscera,  which  the  best  of  bandages 
can  do  only  in  a  very  small  degree,  but  to  increase 
the  intra-abdominal  pressure  to  such  a  degree  as  to 
assist  the  colon  in  disposing  of  its  contents.  Some 
oatients  are  completely  relieved  of  constipation  by 
the  use  of  a  proper  bandage. 

In  m.ost  cases  it  is  necessary  to  employ  perineal 
bands  to  keep  the  bandage  in  position  at  the  lower 
abdomen,  where  alone  it  can  be  of  service. 


EXERCISES  FOR  CONSTIPATION  299 

Pain  in  the  back  is  one  of  the  disagreeable  symp- 
toms which  an  efficient  bandage  often  relieves,  es- 
pecially when  the  pain  is  due  to  enteroptosis,  or 
prolapse  of   the   intestines,   rather  than  colitis. 

A  sense  of  exhaustion,  often  resulting  from  low 
intra-abdominal  tension,  which  permits  an  undue 
amount  of  blood  to  accumulate  in  the  abdominal 
vessels,  robbing  the  brain  and  spinal  cord,  is  almost 
immediately  relieved  by  a  proper  bandage. 

The  bandage  is  only  a  palliative,  however,  and 
its  use  must  be  accompanied  by  the  development 
of  the  abdominal  muscles  by  means  of  massage, 
electricity,   and   suitable   exercises. 

In  cases  requiring  the  use  of  the  abdominal 
supporter  during  the  day,  the  moist  abdominal  girdle 
should  be  worn  at  night  to  aid  in  relieving  con- 
gestion. The  bandage  should  be  used  with  the 
mackintosh  protection,  and  the  bandage  should  be 
removed  or  renewed  before  it  becomes  dry. 


Efficient  Electrical  Methods 

While  electricity  is  certainly  not  a  panacea  for 
constipation,  nor  for  any  other  disease,  and  is  cer- 
tainly not  able  to  accomplish  a  tithe  of  the  miracles 
which  have  been  attributed  to  it,  it  is  neverthe- 
less, when  skillfully  applied,  a  most  valuable  remedy 
in  constipation.  As  ordinarily  used  by  means  of 
sponges  held  in  the  hands,  and  employing  a  current 
from  a  small  buzzing  faradic  machine,  nothing 
more  is  accomplished  than  a  slight  titillation  of  the 
skin  and  giving  the  patient  a  slight  amount  of 
pain,  which  may,  however,  in  some  cases,  exercise 
a  beneficial  psychological  effect. 

Electricity  may  render  valuable  service  in  con- 
stipation in  two  ways:  (1)  By  inducing  automatic 
exercise  of  the  abdominal  muscles  and  so  restoring 
their  tone  and  strength;  and  (2)  by  stimulating 
the  colon  itself  and  thus  inciting  bowel  action,  and 
(3)  by  restoring  lost  nerve  sensibility  to  the  rectum. 
This  it  does  both  by  directly  exciting  bowel  action 
and  by  raising  to  activity  sensibility  of  the  rectum 
when  lost  by  neglect. 

Automatic  Exercise 

Automatic  exercise  of  the  abdominal  muscles 
may  best  be  administered  by  the  aid  of  the  nim- 
soidal  electrical  current.  -  The  static  farradic  cur- 


EFFICIENT  ELECTRICAL  METHODS         301 

rent  may  be  used,  but  they  are  more  or  less  painful 
and  less  easily  controlled.  The  sinusoidal  current  is 
practically  painless.  The  most  convenient  method 
of  using  the  current  is  by  m.eans  of  the  automatic 
exercise  apparatus,  which  may  be  adjusted  so  as 
to  cause  any  desired  number  of  vigorous  contrac- 
tions of  the  abdominal  muscles  per  minute. 

By  this  means  the  abdominal  muscles  and  the 
nerves  and  ner\'e  centers  which  control  them  may 
be  powerfully  stimulated  and  their  functions  grad- 
ually restored. 

Electrical  Stimulation  of  the  Colon 

Applications  of  electricity  to  the  surface  of  the 
body  do  not  excite  action  in  the  colon ;  but  the 
colon  m,ay  be  excited  by  the  application  of  the 
current  directly  to  the  interior  of  the  colon.  This 
cannot  be  done  by  the  patient  himself,  as  the  ser- 
vices of  an  expert  proctologist  are  needed  for  the 
proper  placing  of  the  electrode. 

Electrical  Stimulation  of  the  Rectum 

The  application  of  the  sinusoidal  current  to  the 
rectum  by  means  of  a  proper  electrode  is  a  most 
effective  means  of  stimulation  of  the  rectum  when 
its  normal  sensibility  has  been  greatly  diminished 
or  greatly  lost  by  neglecting  to  attend  properly  to 
Nature's  "call"  for  evacuation  of  the  bowels.  For 
this  purpose  the  very  rapidly  alternated  current  is 


302  COLON  HYGIENE 

best.  The  applications  should  be  made  daily.  The 
duration  of  the  application  should  be  about  ten  or 
fifteen  minutes,  and  the  strength  of  the  current  as 
much  as  the  patient  can  bear  without  discomfort. 
Not  infrequently  the  effect  of  the  application  is  to 
provoke  an  immediate  evacuation  of  the  bowels. 

Diathermy  or  Thermo-penetration 

This  new  application  of  electricity  which  we 
owe  to  Dr.  Nagelschmidt,  of  Berlin,  is  a  most  in- 
teresting medical  use  of  the  so-called  wireless 
electrical  current.  In  the  body  the  high  frequency 
waves  of  electrical  energy  are  wholly  converted 
into  heat  so  that  no  electrical  sensation  or  other 
sensation  except  heat  is  felt.  The  special  advan- 
tage of  diathermy  over  other  forms  of  heat  applica- 
tions is  that  the  heat  may  be  applied  to  the  deepest 
parts  as  easily  as  to  superficial  parts.  This  is  due 
to  the  wonderful  penetrating  power  of  this  current. 

Diathermy  is  a  valuable  means  for  employment 
in  the  treatment  of  colitis.  The  application  of 
the  current  to  the  spastic  colon  causes  it  to  relax, 
and  likewise  relieves  the  pain  in  the  colon  as  well 
as  the  back  and  other  reflexly  related  parts. 


Special  Treatment  of  Different 
Types    of   Constipation 

The  practical  management  of  cases  of  constipa- 
tion is  in  its  main  features  the  same  irrespective 
of  the  type  or  form  which  the  disease  may  assume. 
However,  there  are  certain  special  features  of  each 
of  the  several  characteristic  phases  of  this  diseased 
condition,  which  require  special  consideration. 

Without  recapitulating  the  details  of  what  has 
been  said  in  the  preceding  chapters  respecting  the 
hygiene  and  preventive  methods,  the  next  few  pages 
will  be  devoted  to  a  summary  of  the  methods  which 
have  proved  most  effective  in  dealing  with  several 
forms  of  constipation. 

Treatment  of  Simple  Constipation 

The  patient  must  set  himself  resolutely  to  im- 
prove his  general  health  in  every  possible  way.  He 
must  avoid  all  habits  known  to  be  injurious,  such 
as  the  use  of  tobacco,  alcohol,  tea  or  coffee.  Indulging 
in  late  hours ;  irregular  meals ;  use  of  rich  and  highly 
seasoned  foods;  unwholesome  dress;  worry;  and 
every  unnecessary  expenditure  of  vital  energy  which 
does  not  bring  with  it  a  compensating  addition  to 
vital  resources,  must  be  resolutely  abandoned.  The 
general  rules  and  principles  which  have  been  set 
forth  in  the  preceding  chapters  respecting  the  reg- 

303 


304  COLON  HYGIENE 

ularity  of  bowel  movement  and  the  use  of  laxative 
foods  in  sufficient  quantity  must  be  scrupulously 
foliovi^ed. 

The  special  exercises  recommended  for  strength- 
ening the  abdominal  muscles,  correcting  wrong 
attitudes  in  sitting  and  standing,  must  be  taken 
systematically  twice  a  day.  Feeble  persons  will, 
of  course,  begin  with  lighter  exercises,  increasing 
their  vigor  as  they  improve.  No  less  than  thirty 
minutes   should   be   devoted   to   exercise   daily. 

The  exercise  bath  is  especially  recommended  be- 
cause it  economizes  time  by  combining  the  tonic 
cold  bath  with  vigorous  exercise  of  the  most  help- 
ful sort. 

In  all  cases  in  which  the  colon  is  prolapsed,  and 
when  there  is  a  flabby  state  of  the  abdominal  mus- 
cles, a  carefully  fitted  abdominal  supporter  must 
be  worn. 

Diet 

The  most  important  of  all  measures  is  the  care- 
ful regulation  of  the  diet,  not  only  with  a  general 
view  to  a  laxative  effect,  but  to  suit  the  needs  of 
the  individual  patient.  It  must  be  remembered 
that,  above  all  things,  the  food  must  be  attractive 
and  it  should  be  eaten  at  such  times  and  in  such 
quantity  that  it  will  always  be  taken  with  keen 
relish.  When  the  mouth  waters  at  the  sight  and 
smell  of  food,  it  is  a  good  sign  that  the  whole  di- 
gestive apparatus  is  ready  to  undertake  the  work  of 
digestion  with  promptness  and  vigor. 


SPECIAL  TREATMENT  305 

The  bill  of  fare  must  as  far  as  possible  be  made 
up  of  food  stuffs  which  leave  a  residue  of  cellulose. 
Fine  flour  bread  should  be  wholly  discarded  from 
the  dietary.  Bread  or  biscuit  made  from  coarse 
graham  meal  or  rye  meal  should  replace  other  bread 
stuffs.  It  is  in  many  cases  advantageous  to  increase 
the  amount  of  cellulose  in  the  bread,  by  the  addi- 
tion to  graham  flour  of  bran  to  the  amount  of  about 
one-tenth  the  weight  of  the  flour.  The  bran  and 
graham  flour  should  be  prepared  from  well  washed 
wheat.  If  such  flour  cannot  be  readily  procured, 
wheat  may  be  purchased,  washed,  dried  and  ground 
in  a  hand  mill.  A  few  bacteria  introduced  into  a 
slice  of  bread  prepared  from  unwashed  wheat 
might  not  in  itself  be  capable  of  doing  any  great 
amount  of  injury,  but  it  must  be  remembered  that 
under  the  favorable  conditions  presented  by  stag- 
nating fecal  matters  in  the  colon,  poison-forming 
bacteria  develop  with  extraordinary  rapidity. 

All  green  vegetables  should  be  freely  used  at 
the  principal  meals.  Potatoes  may  be  eaten  in 
moderation,  but  should  not  constitute  the  chief 
vegetable  food,  for  the  reason  that  they  are  almost 
completely  digested,  containing  a  minimum  amount 
of  cellulose,  as  will  be  seen  by  reference  to  the 
table  of  vegetable  foods.  It  is  well  to  select  those 
vegetables  which  are  richest  in  cellulose.  When  the 
digestion  is  fairly  good,  such  vegetables  as  beet- 
root, spinach,  squash,  asparagus,  cabbage,  carrots, 
turnips,  and  cauliflower  should  be  very  freely  used. 


306  COLON  HYGIENE 

Two  or  three  of  these  vegetables  may  be  taken  at 
each  meal.  Uncooked  vegetables  of  some  sort 
should  be  taken  at  least  twice  a  day  at  the  principal 
meals.  Lettuce,  celery,  cucumber  and  cabbage 
may  always  be  taken  with  the  greatest  advantage, 
when  the  digestion  is  fairly  good.  There  are  very 
few  who  cannot  take  one  or  more  of  these  green 
vegetables  if  care  is  taken  to  observe  that  they  are 
fresh  and  crisp,  and  pains  are  taken  to  masticate 
thoroughly.  Even  radishes  may  be  eaten  in  modera- 
tion, if  the  irritating  skin  is  removed. 

Fruit,  both  stewed  and  fresh,  should  constitute 
a  part  of  each  meal.  Fruit  is  especially  valuable 
for  the  last  meal  of  the  day,  and  fresh  fruit  may  be 
taken  with  advantage  just  before  retiring  at  night, 
and  as  an  early  meal  by  those  who  rise  early  and 
breakfast  late.  The  acids  and  sugars  in  fruits 
stimulate  bowel  action,  but  to  secure  this  efFect 
they  must  be  taken  in  considerable  quantity.  Those 
who  take  two  meals  a  day  may  often  take  with 
advantage  two  or  three  oranges  or  as  many  apples 
just  before  going  to  bed  at  night.  Juicy  fruit  re- 
quires no  work  of  the  digestive  organs,  except  to 
move  it  along  and  absorb  the  predigested  nutrient 
which  it  contains.  This  remark,  of  course,  does 
not  apply  to  such  fruits  as  dates,  which  contain  a 
considerable  amount  of  cane  sugar,  nor  to  the 
banana,  which  is  really  quite  a  hearty  food,  but 
relates  only  to  such  juicy  fruits  as  oranges,  apples, 
peaches,   apricots,  berries,   pears  and  grapes. 


SPECIAL  TREATMENT  307 

When  the  bill  of  fare  consists  largely  of  such 
food  stuffs  as  fruits  and  vegetables,  it  is  necessary 
to  give  careful  attention  to  the  actual  food  content 
of  the  meal.  There  is  a  wide  variation  in  the 
amount  of  nutriment  contained  in  different  fruits 
and  vegetables.  For  example,  an  ordinary  serving 
of  potatoes  represents  100  calories  of  food,  while 
a  serving  of  cauliflower  represents  25,  and  is  mostly 
wood  and  water.  A  serving  of  beetroot  represents 
25  calories,  while  a  serving  of  cabbage  or  lettuce 
contains  only  7  calories. 

Many  persons  suffering  from  constipation  find 
it  better  to  take  two  meals  a  day  rather  than  a 
larger  number.  A  full  meal  is  a  much  stronger 
stimulus  to  the  stomach  and  to  the  intestine  than 
a  mere  "bite"  of  food  or  a  half  meal.  By  taking 
two  good  sized  meals  a  day,  a  good  bowel  move- 
ment may  usually  be  secured  after  each  meal,  while 
the  same  quantity  of  food  taken  at  three  or  four 
meals  might  produce  but  one  thorough  movement, 
the  stimulus  of  the  smaller  meals  being  only  suffi- 
cient to  produce  a  partial  emptying  of  the  intestine. 
The  question  as  to  the  number  of  meals  is  one 
that  should  receive  careful  consideration,  and  often 
requires  the  exercise  of  the  best  skill  and  judg- 
ment. Stomachs  which  empty  slowly  require  a 
longer  interval  between  meals. 

It  is  especially  important  that  care  should  be 
taken  to  include  in  the  bill  of  fare  a  sufficient 
amount  of  fat.     Fat  is  not  only  a  nutrient  of  the 


303  COLON  HYGIENE 

very  highest  value,  but  it  is  a  laxative  food  ele- 
ment, partly  because  by  its  use  the  secretion  of  the 
bile  and  other  intestinal  juices  is  promoted,  so  that 
the  intestine  is  benefited  by  their  laxative  influence, 
and  also  because  a  portion  of  the  fat  remains  be- 
hind unabsorbed,  acting  as  a  lubricant  and  also 
as  a  stimulant  to  the  colon. 

Most  cases  of  simple  constipation  are  promptly 
relieved  by  the  adoption  of  the  measures  above 
recommended.  The  amount  of  bran  may  be  in- 
creased almost  ad  libitum  when  necessar5^  In 
addition  to  the  bran  taken  in  the  food,  one  or  even 
two  heaping  tabiespoonfuls  of  cooked  and  sterilized 
bran  may  be  taken  at  each  meal.  Palatable  prep- 
arations of  bran  are  now  available  which  makes 
possible  the  free  use  of  this  most  important  aid  to 
bowel   action   without   inconvenience. 

If  any  further  assistance  is  needed  it  is  to  be 
found  in  the  use  of  white  Russian  paraffin  oil,  the 
details  concerning  which  having  been  given  in  a 
preceding  chapter.      (See  pages  260-270.) 

Treatment  of  Cnmulative  Constipation 

In  the  treatm.ent  of  cumulative  constipation  it 
is  to  be  borne  in  mind  that  the  principal  obstacle 
to  bowel  movement  is  the  undue  accumulation  of 
fecal  matters  either  in  the  pelvic  colon  or  the 
rectum,  or  as  is  most  often  the  case,  in  both  the 
pelvic  colon  and  the  rectum.     In  many  cases    the 


SPECIAL  TREATMENT  309 

food  is  carried  from  the  stomach  to  the  colon  with 
a  proper  degree  of  rapidity,  and  the  feces  move  at 
the  normal  rate  through  the  colon,  until  they  have 
passed  the  splenic  flexure.  At  this  point  the  delay 
begins.  In  time,  through  extraordinary  neglect, 
when  the  feces  are  allowed  to  accumulate  for  days 
and  even  weeks  in  succession,  the  colon  and  even  the 
small  intestine  may  become  enlarged  through  the 
obstruction  at  the  outlet. 

The  chief  cause  of  cumulative  constipation,  in 
ordinary  cases,  as  has  already  been  pointed  out,  is 
neglect  to  attend  to  the  "call"  of  Nature  for  the 
evacuation  of  the  bowels.  When  the  "call"  occurs, 
it  is  because  the  rectum  is  distended  with  feces. 

If  the  defecating  mechanism  then  is  interrputed 
in  its  action,  and  its  purpose  thwarted  many  times, 
the  "call"  becomes  residuary,  and  the  effort  to 
defecate  is  so  slight  that  it  is  easily  suppressed. 
Later,  in  the  worst  cases,  the  desire  to  evacuate 
the  bowels  entirely  disappears.  In  these  cases  the 
sensibility  of  the  rectum  has  become  blunted  ta 
such  a  degree  that  the  normal  reflex  is  lost.  The 
rectum  tolerates  the  presence  of  feces  without  pro- 
test and  without  giving  any  signal  to  the  defecating 
center  that  bowel  movement  is  required. 

It  is  evident,  then,  that  In  the  treatment  of  cases 
of  cumulative  constipation  the  first  and  most  essen- 
tial thing  is  restoration  of  the  normal  sensibility 
of  the  rectum.     It  must  be  remembered,  however^ 


310  COLON  HYGIENE 

that  In  most  cases  of  cumulative  constipation,  as  well 
as  in  other  forms  of  constipation,  the  condition  has 
existed  for  a  long  time.  The  disease  has  conse- 
quently extended  to  the  entire  colon, '  and  perhaps 
to  the  entire  intestine,  and  success  will  not  be  ob- 
tained by  attention  to  the  colon  and  rectum  alone; 
consequently,  the  treatment  of  cumulative  constipa- 
tion requires  the  use  of  all  the  measures  which  have 
been  recommended  for  simple  constipation,  the  de- 
scription of  which  need  not  be  repeated  here. 

The  first  thing  to  be  done,  in  beginning  the  treat- 
ment of  cumulative  constipation  is  to  thoroughly 
evacuate  the  lower  bowel  and  rectum.  This  is 
best  accomplished  by  the  use  of  the  enema.  It  is 
certainly  irrational  to  administer  a  laxative  or 
cathartic,  which  disturbs  the  alimentary  canal 
through  its  whole  length,  for  the  purpose  of  remov- 
ing an  obstructive  accumulation  which  perhaps  lies 
within  six  inches  of  the  lower  outlet. 

A  simple  water  enema  at  a  temperature  of  104° 
to  110°  should  be  given  to  soften  the  hardened  feces, 
and  should  be  repeated  at  intervals  of  half  an  hour, 
until  the  colon  is  completely  emptied,  as  shown  by 
the  return  of  clear  water.  The  addition  of  soap 
to  the  water  sometimes  hastens  the  softening  of  very 
hard  fecal  matter.  Warm  oil  has  been  much  recom- 
mended, but  it  dissolves  hard  feces  less  rapidly  than 
water.  At  first  it  may  be  impossible  to  introduce 
more  than  a  small  quantity  of  water,  on  account 
«f  the  extreme  distention  of  the  rectum  and  pelvic 


,       SPECIAL  TREATMENT  311 

colon  with  feces.  By  a  persevering  eifort,  however, 
success  will  be  attained ;  as  the  hard  feces  are  gradu- 
ally softened  and  dissolved,  larger  quantities  of 
water  may  be  introduced  until  the  whole  colon  may 
be  filled  with  water  and  emptied  of  its  putrefying 
contents.  In  cases  in  which  the  fecal  accumulation 
has  been  going  on  for  several  weeks,  the  patient 
must  be  put  in  charge  of  an  experienced  nurse, 
v/hose  efforts  under  careful  instruction,  must  be 
unremitting  until  the  task  is  completely  accom- 
plished. When  the  feces  are  very  hard,  and  the 
masses  of  considerable  size,  oil  should  be  used  at 
intervals  to  lubricate  the  walls  of  the  bowels,  which, 
in  such  cases,  are  often  dry  and  sometimes  rough- 
ened. 

After  the  bowels  have  been  first  thoroughly 
em.ptied,  infinite  care  must  be  taken  to  see  that  an- 
other accumulation  never  occurs.  Every  time  the 
bowel  is  distended  by  fecal  accumulation,  its  muscles 
are  weakened,  the  sensibility  of  its  nerves  dimin- 
ished, and  any  improvement  which  may  have  been 
secured  by  previous  treatment  is  lost.  By  the  sys- 
tematic use  of  the  enema,  the  bowel  being  kept 
empty,  gradually  contracts  and  returns  to  something 
like  its  normal  proportions. 

The  cold  enema  should  always  be  used  for  con- 
tracting the  bowel  after  the  fecal  matters  have  been 
removed  by  a  warm  enema.  When  once  the  bowel 
has  been  thoroughly  emptied,  warm  water  may  no 
longer  be  required,  and  it  will  not  be  necessary  to 


312  COLON  HYGIENE 

resort  to  the  use  of  the  hot  enema.  The  tempera- 
ture of  the  water  ordinarily  used  for  the  evacuation 
of  the  bowels  may  then  be  about  80°.  After  a  little 
training,  a  lower  temperature  may  readily  be  toler- 
ated and  is  greatly  preferable.  When  very  cold 
water  is  used,  the  effect  is  sometimes  to  produce  a 
spasm  of  the  anus,  so  that  the  contraction  of  the 
muscles  prevents  proper  movement.  When  this 
occurs,  the  anus  may  be  relaxed  by  the  application 
of  a  sponge  or  napkin  saturated  with  very  hot  water, 
or  water  of  a  higher  temperature  may  be  used  for 
the  enema. 

The  best  time  for  administering  the  enema  is  in 
the  morning,  after  breakfast;  but  if  circumstances 
will  not  permit  this,  the  bowels  may  be  moved  at 
night  after  supper,  or  just  before  retiring.  With 
patients  who  suffer  from  hemorrhoids  or  painful 
ulcers  of  the  rectum,  the  hour  of  retiring  is  the  best 
time  for  moving  the  bowels  by  an  enema,  as  after- 
ward there  may  be  prolonged  rest  on  the  back.  This 
prevents  the  extrusion  of  swollen  hemorrhoids  or 
prolapsing  rectum,  and  gives  rest  to  the  anal  muscles, 
and  so  prevents  the  nagging,  painful  contractions 
which  often  follow  bowel  movement  when  fistulae 
or  ulcers  are  present. 

By  the  systematic  use  of  the  cold  enema  the  di- 
lated colon  may  gradually  be  restored  to  its  normal 
size;  its  relaxed  walls  will  recover  their  tone,  and 
its  function  will  be  more  properly  performed.  When 
sensibilit)'^  of  the  rectum  has  been  lost  it  m.ay  also 


SPECIAL  TREATMENT  313 

gradually  be  recovered.  It  is  necessary,  however, 
that  the  greatest  care  should  be  taken  to  see  that  tK'e 
colon  and  rectum  are  never  once  distended  by  fecal 
accumulation.  Many  persons  suffering  from  cumu- 
lative constipation  take  an  enema  every  other  day, 
or  once  or  twice  a  week,  waiting  for  symptoms  of 
accumulation  before  the  enema  is  taken.  This  prac- 
tice is  altogether  wrong,  and  results  only  in  a  per- 
petuation of  the  disease.  Of  course,  when  an  ac- 
cumulation occurs,  it  must  be  removed,  but  if  a 
cure  is  expected,  accumulations  must  not  be  per- 
mitted to  occur. 

In  obstinate  cases  the  application  of  a  sinusoidal 
electric  surrent  to  the  colon  and  the  rectum  aids 
greatly  in  the  restoration  of  these  parts  to  a  normal 
condition.  By  the  use  of  special  electrodes  electricity 
may  be  applied  to  the  interior  of  the  colon,  as  vrell 
as  to  the  rectum,  thus  securing  vigorous  contractions 
of  the  bowel,  which  are  not  always  produced  by  ex- 
ternal applications,  especially  in  chronic  cases  in 
which  the  intestine  has  to  a  large  degree  lost  its 
normal  sensibility.  While  strong  electrical  appli- 
cations made  to  the  spine  and  abdomen  sometimes 
stimulate  the  muscles  of  the  intestine  as  well  as  those 
of  the  abdominal  wall,  when  the  intestinal  muscles 
have  long  been  over-stretched  and  are  perhaps  to 
some  degree  degenerated,  direct  applications  are 
necessary.  These  must  be  made  by  a  physician  by 
the  aid  of  the  proctoscope,  which  can  be  readily 
passed  into  the  pelvic  colon. 


314  COLON  HYGIENE 

Vibration  and  mass^e  of  the  interior  of  the 
rectum  are  measures  of  doubtful  value.  They  are 
likely  to  give  rise  to  abrasion  and  irritation  of  the 
mucous  membrane,  and  are  not  to  be  recommended. 

In  cases  of  cumulative  constipation,  in  which 
painful  ulcer  or  irritable  hemorrhoids  exist,  effort 
to  restore  normal  action  of  the  bowels  may  be  made 
ineffective  by  spasm  of  the  sphincter  muscles.  This 
may  be  relieved  temporarily  by  external  applications 
of  heat  by  means  of  a  fomentation.  A  very  effective 
plan  is  to  move  the  bowels  while  sitting  over  hot 
water.  Boiling  hot  water  may  be  poured  into 
a  chamber  or  other  suitable  vessel.  The  steam  re- 
laxes the  anal  sphincters,  and  not  only  facilitates  the 
bowel  movement,  but  relieves  or  prevents  the  pain. 

Dryness  of  the  lower  bowel  due  to  deficient 
secretion,  the  result  of  chronic  proctitis  and  asso- 
ciated with  loss  of  rectal  sensibility,  is  not  infre- 
quently a  cause  of  obstinate  cumulative  constipation. 
The  stools  are  exceedingly  hard  and  drj'-,  and  are 
discharged  with  great  difficulty.  When  the  rectum 
of  such  a  patient  is  examined,  the  mucous  membrane 
is  found  to  be  exceedingly  dry,  and  often  irritated. 
The  normal  lubricating  mucus  is  not  present.  The 
result  is  the  delay  of  the  feces  in  the  rectum  until  a 
dry  hard  mass  is  formed,  which  is  not  easily  gotten 
rid  of.  In  such  cases,  lubrication  of  the  recrum 
is  needed.  The  remedy  for  this  is  paraffin,  of  a 
special  sort  which  melts  at  102°  F.  For  details 
respecting  the  use  of  this  highly  valuable  remedy 
see  pages  260-270. 


SPECIAL  TREATMENT  315 

Treatment  of  Latent  Constipation 

In  this  form  of  constipation  the  stools  are  regular, 
the  bowels  move  every  day,  and  there  is  no  accumu- 
lation of  feces  in  the  rectum.  The  patient  is  gen- 
erally unaware  of  the  fact  that  he  is  suffering  from 
constipation,  although  not  infrequently  an  observing 
patient  becomes  satisfied  that  there  is  something 
wrong,  often  because  of  too  frequent  bowel  move- 
ments, which  are  not  uncommon,  together  with  pain, 
the  passage  of  mucus,  perhaps,  and  other  symptoms. 

In  a  London  clinic  the  writer  once  heard  a 
Scotch  laborer  complain  of  very  frequent  bowel 
movement.  The  examining  doctor  said  to  him, 
"Then  you  are  suffering  from  diarrhcfia".  "No, 
Doctor,"  replied  the  patient,  "I  think  I  am  suffer- 
ing from  constipation  in  diarrhoea  form," — a  good 
practical  description  of  certain  forms  of  latent  con- 
stipation. This  patient  was  found  to  have  a  very 
extensive  accumulation  of  feces  due  to  cancer  of  the 
rectum. 

In  addition  to  the  most  thoroughgoing  application 
of  all  the  measures  recommended  for  simple  con- 
stipation, a  thorough  examination  including  an 
X-ray  inspection  of  the  whole  intestinal  tract,  after 
a  bismuth  meal  must  be  made.  The  rectum  and 
lower  bowel  must  be  carefully  examined  to  exclude 
cancer  or  other  organic  disease.  Careful  examina- 
tion must  be  made  in  the  region  of  the  appendix, 
and   in   women   a   thorough   pelvic  examination   is 


316  COLON  HYGIENE 

necessan',  since  in  many  cases  the  delaj^  may  occur 
above  the  ileocecal  valve,  in  consequence  of  spasm  of 
the  sphincter  at  this  point.  Or  the  delay  may  be 
due  to  incompetency  of  the  ileocecal  valve. 

"Lane's  kink"  may  be  an  occasional  cause  of 
latent  constipation.  It  is  more  likely  to  be  a  result 
of  this  condition. 

"When  the  difficulty  is  due  to  spasm  of  the  ileo- 
cecal valve,  the  result  of  reflex  irritation  from  the 
inflamed  appendix  or  from  inflammation  of  the 
ovaries,  uterus,  bladder,  or  prostate,  or  painful 
disease  of  the  rectum,  it  is  of  course  necessary-  that 
these  conditions  should  be  removed  bj^  proper  treat- 
ment. Temporary  relief  is  generally  most  readily 
obtained  by  hot  fomentations  over  the  abdomen- 
with  special  attention  to  the  seat  of  pain.  The  hot 
sitz  bath,  the  hot  enema  and  the  wet  girdle  covered 
with  mackintosh,  worn  day  and  night,  are  measures 
of  great  im.portance,  and  often  secure  ver}^  complete 
and  speedy  relief. 

When  the  intestinal  inactivit)'-  is  the  result  of 
general  feebleness,  short  cold  baths  should  be  em- 
ployed daily.  A  cold  bath  may  consist  of  a  general 
cold  shower  of  from  fifteen  to  twent}'  seconds'  dura- 
tion, a  cold  douche  to  the  spine,  a  cold  towel  rub, 
or  cold  sheet  rub,  according  to  the  strength  of  the 
patient.  The  cold  bath  should  be  preceded  by  a 
short  electric  light  bath.  It  aids  in  the  elimination 
of  accumulated  toxins,  and  prepares  the  skin  to  react 
to  cold  application. 


SPECIAL  TREATMENT  317 

In  latent  constipation,  the  enema  is  sometime? 
useful  chiefly  as  a  means  of  introducing  water  by 
which  the  accumulated  toxins  may  be  washed  out 
through  the  kidneys.  In  such  cases  the  difficulty 
lies  too  high  to  be  reached  by  the  enema.  The  large 
cool  or  cold  enema  may,  however,  render  service  in 
cases  in  which  the  delay  is  due  to  atony,  by  improv- 
ing the  tone  of  the  bowel  muscles  and  so  aiding  peris- 
taltic movement,  by  which  the  accumulated  putrefy- 
ing material  in  the  lower  part  of  the  intestine  may 
be  moved  on  to  the  colon,  and  so  be  gotten  rid  o£ 
The  cold  enema  should  not  be  used,  however,  in 
cases  where  there  is  reason  to  suspect  spasm  of  the 
ileocecal  valve,  which  is  likely  to  be  the  case  v/hea 
latent  constipation  is  associated  with  painful  disease 
in  any  part  of  the  pelvic  region.  In  these  cases  a  hot 
enema  should  be  employed. 

The  rapid  absorption  of  water  from  the  colon 
is  shown  by  the  copious  discharge  of  urine  which 
usually  appears  within  a  few  minutes  after  an  enema 
is  taken.  The  increase  in  the  quantity  of  urine 
occurs  so  quickly  after  a  large  enema,  that  some 
medical  writers  in  the  early  part  of  the  last  century 
were  led  to  advance  the  theory  that  a  direct  con- 
nection existed  between  the  colon  and  the  kidneys. 
This  fanciful  theory  has,  of  course,  no  anatomical 
foundation. 

Mechanical  kneading,  the  application  of  the- sinu- 
soidal current,  and  intelligently  administered  mas- 
sage and  other  means  by  which  success  may  be 
attained  in  combatting  latent  constipation. 


318  COLON  HYGIENE 

The  Treatment  of  Spastic  and  Reflex 
Constipation 

These  conditions,  most  commonly  associated  with 
colitis  or  appendicitis,  require  the  use  of  special 
measures.  In  spastic  constipation  the  cause  of  stag- 
nation of  the  intestinal  contents  may  rest  anywhere 
between  the  ileocecal  valve  and  the  anus. 

In  many  cases  of  so-called  spastic  constipation, 
this  condition  is  only  a  complication  of  colitis  or 
chronic  infection  of  the  colon,  due  to  delay  of  fecal 
matters  in  the  colon. 

The  best  means  of  securing  immediate  relief  in 
cases  of  this  sort  are  the  hot  sitz  bath,  the  hot 
enema,  and  hot  fomentations  or  diathermy  applied 
over  the  abdomen. 

In  cases  of  painful  disease  of  the  ovaries  or  uterus, 
the  hot  vaginal  irrigation  must  be  used  in  addition 
to  the  hot  enema. 

The  constipation  which  occurs  at  the  monthly 
period  in  women  suffering  from  menorrhagia,  may 
often  be  removed  by  a  hot  hip  and  leg  pack  applied 
by  means  of  a  woolen  blanket  wrung  out  of  water 
as  hot  as  possible.  The  application  of  cold  water 
after  the  pack  should  be  avoided.  The  patient 
should  be  wrapped  in  dry  blankets,  and  gradually 
cooled  by  tepid  spraying. 

Sometimes  the  warm  oil  enema  proves  more  ser- 
viceable than  the  hot  water  enema,  because  less 
irritating.     The  addition  of  salt  to  the  water  is 


SPECIAL  TREATMENT  319 

sometimes  useful  in  cases  in  which  the  mucous  mem- 
brane of  the  intestine  is  eroded,  as  a  weak  solution 
of  salt  is  less  irritating  to  raw  surfaces  than  pure 
water. 

The  application  of  the  arc  light  and  the  photo- 
phore  are  extremely  useful  means  of  relieving  the 
internal  spasm.  These  applications  should  be  made 
daily  for  ten  to  fifteen  minutes'  duration.  In 
severe  cases  the  light  applications  may  be  intensified 
by  a  special  device  through  which  the  excessive  rise 
of  temperature  is  prevented  by  a  stream  of  cool  ait 
or  water  playing  upon  the  abdomen. 

When  making  general  cold  applications,  the  abdo- 
men should  be  protected  by  a  warm  flannel  or  a  hot 
fomentation.  A  patient  suffering  from  constipation 
must  take  special  care  to  avoid  chilling,  and  must 
keep  the  feet  and  hands  warm.  The  chilling  of  the 
hands  and  feet  always  aggravates  the  spasm.  The 
drinking  of  ice-cold  water  must  also  be  prohib- 
ited. 

The  cold  towel  rub  is  especially  suited  to  these 
cases,  as  a  general  tonic  measure. 

A  person  skilled  in  massage  may  make  good  use 
of  this  measure  in  the  general  application  of  heat,  in 
cases  in  which  massage  is  indicated,  as  when  the 
cecum  is  loaded  as  the  result  of  contraction  of  the 
transverse  colon,  or  at  the  splenic  flexure.  The  ten- 
denq'  of  massage  to  aggravate  the  contraction  is 
counteracted  by  a  general  application  of  heat. 

The  moist  abdominal  bandage  without  the  mack- 


320  COLON  HYGIENE 

intosh  cover  should  be  done  at  night  and  if  possible 
also  during  the  day  time. 

The  abdominal  supporter  is  also  highly  important 
in  these  cases,  to  prevent  drag  upon  the  mesentary 
by  prolapse  of  the  bovv^els.  The  writer  has  ob- 
served several  cases  in  which  the  wearing  of  an 
efficient  abdominal  supporter  has  given  prompt  re- 
lief from  very  obstinate  constipation. 

The  Treatment  of  Mixed  Cases  of 
Constipation 

In  many,  perhaps  the  majority  of  cases  of  con- 
stipation, the  type  of  the  disease  is  mixed.  The 
association  of  spastic  constipation  with  latent  or 
cum.ulative  con  tipation  is  specially  common.  Cases 
which  begin  as  simple  constipation,  later  become 
cumulative  constipation,  and  finally  develop  spastic 
or  latent  constipation  through  infection  of  the  colon, 
or  colitis,  the  natural  result  of  stagnation  of  the 
bowel  contents. 

The  measures  recommended  for  the  treatment 
of  spastic  constipation  should  be  applied  with  such 
other  measures  as  may  be  indicated.  If  the  rectum 
and  the  pelvic  colon  are  filled  with  feces,  these 
must  be  removed  by  the  means  recommended  in  the 
treatment  of  cumulative  constipation,  and  the  gen- 
eral measures  suggested  for  the  relief  of  that  form 
of  the  disease  must  be  perseveringly  employed. 

In  the  use  of  electricity  in  cases  of  this  sort,  the 


SPECIAL  TREATMENT  321 

applications  must  be  combined  with  hot  appllcationst 
in  order  to  avoid  increase  of  the  spastic  contraction. 

When  electricity  is  applied  to  the  rectum,  a 
fomentation  should  be  applied  to  the  abdomen  dur- 
ing  the   application,   or   immediately   afterward. 

The  thermophore  affords  the  most  effective  means 
of  applying  heat  to  the  abdomen  during  electrical 
applications.  During  a  general  cold  application 
heat  should  be  applied  over  the  abdomen,  to  pro- 
tect the  intestine. 

A  flannel  bandage  should  be  worn  over  the 
abdomen  constantly  when  the  moist  abdominal 
bandage  is  not  employed,  and  an  abdominal  sup- 
porter should  be  v/orn. 

Coarse  vegetables  and  other  bulky  food  stuffs 
should  not  be  avoided  because  colitis  is  present 
Colitis  is  the  result  of  constipation,  and  this  will  be 
aggravated  by  the  bland  concentrated  diet,  which 
is  commonly  recommended  for  colitis.  Experience 
has  very  clearly  demonstrated  the  value  of  a  bulky 
vegetable  diet  in  colitis  as  well  as  in  constipation. 

Agar-agar  is  specially  valuable  in  these  cases,  for 
the  reason  that  it  affords  bulk,  and  aids  in  clearing 
away  the  accumulated  mucus,  while  at  ■  the  same 
time  producing  no  irritation.  The  irritation  sup- 
posed to  rise  from  the  cellulose  of  fruits  is  far  less 
than  is  generally  thought.  Bran  and  ground  wood 
have  been  used  with  excellent  results  as  poultices 
for  raw  surfaces  and  dressings  for  wounds.  Wet 
bran,  like  wet  paper,  is  not  irritating. 


Treatment  of   Disorders   Which 
Result  from  Constipation 

While  constipation,  through  the  autointoxication 
to  which  it  leads,  is  both  an  exciting  and  predis- 
posing cause  of  many  very  serious  chronic  diseases 
from  which  human  beings  suffer,  there  are  many 
other  maladies  which  are  so  immediately  aggravated 
by  an  inactive  state  of  the  bowels,  that  this  condi- 
tion becomes  a,  dominant  factor  in  dealing  with 
them.  In  this  chapter  a  brief  mention  will  be  made 
of  the  more  important  of  these  diseases. 

Catarrhal  Colitis 

The  chief  seat  of  this  disease  is  the  lower  colon, 
especially  the  pelvic  colon  and  the  iliac  colon. 
Sometimes,  however,  the  effect  extends  to  the 
entire  colon. 

The  disease  is  essentially  a  chronic  infection  of 
the  mucous  membrane,  and  is  the  result  of  the 
injury  done  to  the  tissues  by  the  prolonged  contact 
with  putrefying  fecal  matters  which  in  constipation 
accumulate  and  are  often  retained  for  days  in  the 
lower  colon.  To  understand  the  effect  of  these 
poisonous  matters  upon  the  mucous  membrane, 
when  acting  continuously  for  days  with  constantly 
increasing  virulence,  it  is  only  necessary  to  consider 
for  a  moment  what  result  would  follow  an  applica- 

222 


TREATMENT  OF  DISORDERS  323 

tion  of  the  same  sort  of  material  to  the  skin 
for  several  days  in  succession.  The  remarkable 
vitality  with  which  the  mucous  membrane  is  en- 
dowed, enables  it  to  retain  its  integrity  for  a  con- 
siderable length  of  time,  but  sooner  or  later,  its 
resistance  breaks  down,  and  it  becomes  the  seat  of 
a  chronic  inflammation  similar  to  that  which  affects 
the  mucous  membrane  of  the  nose  in  nasal  catarrh. 
An  examination  of  the  stools  shows  constantly 
present  mucous  and  white  blood  cells,  which  are 
thrown  off  by  the  mucous  membrane  in  its  efforts 
to  defend  itself  against  the  attack  of  the  myriads 
of  microbes  which  are  constantly  assailing  it,  and 
the  various  highly  virulent  poisons  which  they 
produce.  The  character  of  these  poisons  may  be 
judged  from  the  nauseous  odors  emanating  from 
the  putrefying  feces  which  are  discharged  when 
a  laxative  is  administered,  and  sometimes  as  the 
result  of  an  enema.  The  real  character  of  the  feces 
produced  by  a  constipated  person  cannot  always  be 
judged  by  an  examination  of  the  hard,  dry  masses 
which  are  discharged  from  the  lower  bowel,  for  the 
reason  that  the  noxious  substances  which  they  con- 
tained have  been  absorbed  higher  up  in  the  bowel. 
Some  persons,  indeed,  have  made  the  mistake  of 
supixising  that  the  comparatively  inodorous  feces 
which  they  discharged,  and  which  have  been 
retained  so  long  that  they  have  become  as  hard  and 
dry  as  wood,  afford  evidence  of  an  exceptionally 
aseptic  and  wholesome  state  of  their  intestine.     In 


324  COLON  HYGIENE 

one  such  case  the  writer  succeeded  in  disabusing 
the  mind  of  a  very  optimistic  individual,  by  ad- 
ministering a  dose  of  charcoal,  which,  acting  as  a 
laxative,  brought  down  from  the  cecum  and  trans- 
verse colon  a  semi-fluid  stool  which  was  loathsome 
almost  beyond  description,  and  which  when  sub- 
mitted to  chemical  and  bacteriological  examination, 
was  shown  to  contain  prodigious  numbers  of 
bacteria,  and  putrefaction  products  in  extraordinary 
amount.  This  person,  a  man  of  unusual  intel- 
ligence, but  unacquainted  with  the  physiolog}^  and 
bacteriology  of  the  intestine,  lived  under  the  er- 
roneous impression  that  by  the  thorough  mastication 
of  his  food  he  rendered  digestion  so  complete,  and 
his  intestine  so  sterile,  that  the  putrefactive  processes 
commonly  present  were  suppressed,  whereas,  the 
truth  was  that  putrefaction  was  very  active  in  his 
colon,  and  his  feces  were  inodorous  only  because 
they  had  been  retained  so  long  that  the  putrefactive 
process  had  consumed  everything  putresicible,  and 
the  maladorous  and  other  substances  had  been  taken 
up  into  the  blood  by  the  absorption,  and  had  been 
discharged  through  the  lungs,  skin  and  kidneys, 
instead  of  being  eliminated  through  the  bowels,  the 
natural  and  only  safe  and  decent  outlet  for  such 
loathsome  products.  In  this  case,  as  might  be  ex- 
pected, evidence  of  the  presence  of  catarrhal  colitis 
was  present,  the  little  knob  of  wooden-like  feces 
discharged  at  intervals  of  several  days,  being  always 
covered  with  a  thick  layer  of  opaque  mucus. 


TREATMENT  OF  DISORDERS  325 

The  frequent  bowel  movement  in  colitis  is  due 
not  only  to  the  irritation  produced  by  the  stagnation 
of  fecal  contents  but  to  the  fact  that  the  contracted 
bowel  relaxes  at  intervals  and  permits  the  passage 
of  material  which  has  been  accumulated  above  it. 
When  the  bowel  is  completely  contracted  the  ob- 
struction is  complete.  In  examining  the  patients 
suffering  from  colitis  the  writer  has  often  noticed 
the  complete  relaxation  of  the  bowel  which  but  a 
few  moments  before  was  so  contracted  that  it  could 
be  rolled  under  the  finger  like  a  piece  of  thick 
rubber  tubing. 

In  catarrhal  colitis,  the  stools  may  be  either 
liquid,  or  composed  of  hard  lumps  somewhat  re- 
sembling the  feces  of  goats,  or  they  may  be  mixed 
in  character.  The  stools  are  sometimes  quite  watery 
in  character,  and  may  contain  traces  of  blood. 
Patients  often  think  that  they  are  suffering  from 
diarrhoea,  on  account  of  the  frequent  semi-liquid 
discharges.  The  cause  of  liquid  stools  is  the  irrita- 
tion produced  by  the  hardened  and  irritating  feces. 
The  irritation  is  not  mechanical,  however,  but  is 
due  to  the  poisonous  and  irritating  substances  which 
are  produced  by  the  bacteria  growing  in  the  feces, 
in  other  words,  by  the  putrefaction  which  is  taking 
place. 

In  many  cases  there  is  a  quite  regular  alternation 
of  constipation  and  diarrhoea;  the  feces  accumulate 
for  several  days,  when  the  irritation  becomes  so 
great  that  by    a    profuse    flow    of    serum    and    an 


326  COLON  HYGIENE 

abundant  secretion  of  mucus  occurs,  the  mass  is 
softened,  and  temporary  relief  is  obtained  through 
the  complete  or  partial  unloading  of  the  bowels  by 
several  soft  stools. 

This  condition,  which  is  usually  associated  with 
cumulative  constipation,  is  often  complicated  by  a 
latent  constipation,  which  results  from  spastic  con- 
traction of  the  bowel.  The  most  common  seat  of 
this  contraction  is  the  descending  or  pelvic  colon; 
but  it  may  often  be  noted  in  the  transverse  and 
ascending  colon.  In  these  cases,  the  autointoxication 
which  is  alwa3^s  present  is  more  pronounced  in 
degree,  because  of  the  more  fluid  character  of  the 
intestinal  contents  in  the  upper  bowel.  That  the 
disease  not  infrequently  extends  to  the  whole  colon 
is  shown  not  only  by  the  contracted  condition  of 
the  ascending  colon  and  even  of  the  cecum,  but 
also  by  the  presence  of  masses  of  hardened  feces 
which  may  be  frequently  felt  in  both  these  portions 
of  the  colon. 

The  ultimate  effect  of  long-continued  inflamma- 
tion of  the  mucous  membrane  is  the  same  in  the 
colon  as  in  the  nose  and  other  parts  provided  with 
a  mucous  lining.  After  a  time,  which  varies  accord- 
ing to  the  resistance  of  the  individual  and  the  in- 
tensity of  the  disease,  degenerative  changes  occur  > 
in  the  mucous  membrane;  its  glands  disappear,  and 
it  becomes  thin  and  parchment-like.  The  degenera- 
tion extends  to  the  muscles  which  lie  beneath  the 
mucous   membrane.      The    intestinal   wall    is   thus 


TREATMENT  OF  DISORDERS  327 

thinned  and  weakened  and  loses  its  power  of  con- 
tractility to  a  large  degree;  it  becomes  distended 
and  enlarged  by  gases  and  fecal  accumulation,  and 
thus  the  difficulty  becomes  greatly  aggravated.  In 
these  cases,  the  colon,  or  at  least  the  portion  of  it 
which  is  affected,  becomes  much  like  a  distended 
bladder,  losing  a  large  part  of  its  functions  as  a 
living  muscular  tube;  it  fails  to  respond  to  the 
nervous  impulses  by  which  the  act  of  defecation 
is  normally  affected,  and  serves  merely  as  a  reservoir 
in  which  accumulate  waste  and  remnants  of  un- 
digested and  undigestible  foodstuffs,  there  to  remain 
undergoing  fermentation  and  putrefaction,  develop- 
ing offensive  gases  and  irritating  poisons,  until  re- 
moved from  the  body  by  some  mechanical  means. 
In  these  cases  an  essential  part  of  the  defecating 
mechanism  is  practically  destroyed  or  rendered  in- 
operative, and  it  becomes  necessary  to  resort  to  me- 
chanical means,  as  an  enema  of  water  or  oil,  for 
emptying  the  bowels.  Lane  and  other  surgeons 
have  removed  the  colon  in  these  cases,  an  operation 
which  is  doubtless  sometimes  necessary,  although 
less  often  required  than  has  been  advocated  by  some, 
provided  the  patient  can  have  the  benefit  of  a  com- 
plete regulation  of  the  dietary,  and  will  follow  a 
suitable  regimen. 

The  disastrous  consequences  which  result  from 
chronic  catarrhal  colitis  are  not  confined  to  the  colon. 
The  disease  often  extends  to  the  small  intestine.  In 
aggrarated   cases   the    accumulation   in    the   cecum 


328  COLON  HYGIENE 

becomes  so  great  that  the  ileocecal  valve  is  dilated 
to  such  an  extent  that  the  contents  of  the  cecum 
and  small  intestine  intermingle.  The  very  perfect 
valve  arrangement  provided  by  Nature  at  the 
junction  of  the  small  intestine  vi^ith  the  colon,  which 
is  rendered  still  more  efFective  by  a  sphincter 
muscle  placed  just  above  it,  is  evidently  intended 
to  prevent  any  possible  return  of  matters  from  the 
colon  to  the  small  intestine.  In  the  small  intestine 
the  presence  of  carbohydrates  prevents  the  growth 
of  putrefactive  organisms,  by  encouraging  the  forma- 
tion of  acids.  In  the  colon,  however,  especially 
when  there  is  stasis  or  accumulation  of  fecal  matters, 
the  delay  permits  the  complete  absorption  of  starch 
and  sugar,  so  that  there  is  no  material  to  encourage 
the  acid-forming  bacteria,  and  the  poison-forming 
microbes,  being  unhindered,  undergo  rapid  develop- 
ment, and  greatly  increase  in  virulence,  finding 
always  plenty  of  food  material  in  the  mucus,  bile,  and 
other  intestinal  secretions,  as  well  as  the  larger  or 
smaller  quantities  of  food  protein  which  remains 
undigested  or  unabsorbed.  When  these  dangerous 
microbes  are  carried  into  the  small  intestine,  they 
may  continue  to  develop  and  gradually  work  their 
way  up  the  intestine. 

The  cecum  becomes  dilated  and  distorted  in 
shape,  because  of  the  weakening  of  its  walls  in 
consequence  of  the  undue  accumulation  of  its  con- 
tents. The  cecum  may  be  so  dilated  and  stretched 
that  it  is  found  far  over  toward  the  left  side  of 


TREATMENT  OF  DISORDERS  329 

the  body,  or  lying  deep  down  in  the  pelvis.  The 
damaged  ileocecal  valve  no  longer  controls  the 
opening  between  the  small  intestine  and  the  colon. 
The  feces  are  no  longer  found  exclusively  in  the 
colon.  The  small  intestine  may  for  several  feet  be 
filled  with  fecal  matters  of  the  consistency  of  putty, 
such  as  are  normally  found  only  in  the  transverse 
colon  and  beyond. 

Putrefaction  of  the  contents  of  the  small  intestine 
is  a  very  much  more  serious  matter  than  putrefaction 
in  the  colon,  for  the  reason  that  the  small  intestine 
is  much  more  richly  supplied  with  absorbents,  and 
is  also  less  prepared  to  defend  itself  against  the  at- 
tacks of  the  virulent  miscrobes  which  are  always 
present   in   connection  with   putrefactive  processes. 

This  infection  of  the  small  intestine  with  fecal 
matters  introduces  a  whole  series  of  troubles  which 
unfold  as  the  infection  ascends  along  the  intestine. 
The  ascending  infection  finally  reaches  the  duo- 
denum, which  not  infrequently  becomes  the  seat  of 
a  chronic  catarrhal  condition,  the  result  of  which 
may  be  ulceration.  Observations  of  Moynihan  and 
others  have  shown  that  duodenal  ulcer  is  three  or 
four  times  as  frequent  as  ulcer  of  the  stomach. 
Pain  occurring  three  or  four  hours  after  meals  is 
very  frequently  due  to  duodenal  ulcer.  From  the 
duodenum,  infection  often  travels  through  the  bile 
ducts  to  the  liver  and  the  gall  bladder.  Chronic  in- 
fection of  the  gall  bladder  and  gall  stones  are  thus 
developed.     The  infection  may  also  ascend  the  pan- 


330  COLON  HYGIENE 

creatic  duct,  which  is  closely  associated  with  the 
bile  duct,  and  may  cause  chronic  inflammation  of 
the  pancreas,  one  of  the  results  of  which  may  be 
diabetes.  From  observations  recently  made  respect- 
ing the  causes  of  diabetes  it  is  probable  that  inflam- 
mation of  the  pancreas  arising  in  this  way  is  among 
the  most  common  causes  of  this  disease.  Observa- 
tions made  in  the  X-ray  department  of  the  Battle 
Creek  Sanitarium  indicate  that  the  ileocecal  valve 
is  usually  incompetent  in  diabetes.  This  is  a  most 
significant  fact.  The  ileocecal  valve  protects  the 
small  intestine  from  infection;  when  it  becomes  in- 
competent, there  is  nothing  to  prevent  the  develop- 
ment of  an  ascending  infectious  process,  which  may 
bring  about  all  of  the  conditions  above  mentioned. 

Treatment 

The  successful  treatment  of  colitis  requires,  first 
of  all,  a  change  of  the  intestinal  flora;  that  is,  the 
infectious  bacteria  to  which  the  disease  is  due  must 
be  gotten  rid  of.  Since  the  first  cause  of  colitis 
is  constipation,  it  is  evident  that  frequent  bowel 
movement  is  also  essential ;  in  other  words,  the  colon 
must  be  kept  clean.  The  diarrhea  which  is  some- 
times present  in  colitis  is  the  result  of  Nature's  ef- 
fort to  clear  the  intestine  from  offending  materials. 
The  mucus  which  is  often  discharged  in  large  quan- 
tities is  a  protective  material  which  Nature  pours 
out  upon  the  surface  of  the  intestine  to  protect  the 
tissues  against  the  attacks  of  bacteria  and  parasites 


TREATMENT  OF  DISORDERS  331 

which  flourish  in  the  colons  of  persons  suffering 
from  this  disease. 

Various  species  of  bacteria  are  capable  of  giving 
rise  to  colitis,  according  to  Tissier.  In  general,  it 
may  be  said  that  colitis  is  the  result  of  the  presence 
in  the  colon  of  excessive  numbers  of  putrefactive 
bacteria. 

In  recent  years,  attention  has  been  called  to 
the  fact  that  acute  infections  of  the  colon  are 
sometimes  due  to  animal  parasites.  Certain  amoebae, 
flagellates,  spirochetes  and  other  forms  of  protozoa 
are  also  found  in  great  numbers  in  the  colon  in  cases 
of  chronic  constipation  and  colitis,  as  well  as  in  cases 
of  amoebic  dysentery.  These  organisms  have  been 
regarded  by  most  authorities  as  pseudo  parasites, 
with  the  exception  of  those  of  amoebic  dysentery. 
Dr.  Ronald  Ross  has  recently  pointed  out  the' fact 
that  all  these  organisms  are  parasitic  and  dangerous. 
If  they  do  not  set  up  acute  inflammation  character- 
istic of  amoebic  dysentery,  they  bore  into  the  mucous 
membrane  and  thus  prepare  hiding  places  for  per- 
nicious bacteria,  which  develop  chronic  infections 
and  intestinal  toxemia.  Observations  made  a  few 
years  ago  by  Miss  York  show  that  these  animal 
parasites  are  rarely  found  in  the  stools  of  persons 
who  subsist  upon  a  non-fiesh  dietary.  They  abound 
in  feces  which  are  in  part  made  up  of  undigested 
residues  of  flesh  foods. 


332  COLON  HYGIENE 

Measures  Essential  in  the  Treatment 
of  Colitis 

As  already  stated,  it  is  necessary  in  the  treat- 
ment of  colitis  first  of  all  to  adopt  thoroughgoing 
measures  to  secure  a  change  of  the  intestinal  flora. 
The  writer  has  found  that  this  may  be  accomplished 
in  a  short  time  by  placing  the  patient  on  a  special 
diet,  which  for  convenience  is  termed  a  fruit  regi- 
men. For  a  description  of  this  regimen  see  page 
191.  After  a  few  days  of  this  regimen  (three  days 
to  a  week)  the  character  of  the  stools  will  be  found 
to  be  wholly  changed.  The  stools  become  soft,  al- 
most odorless  and  frequent,  the  tongue  clears,  the 
appetite  is  keen  and  is  satisfied  with  simple  foods. 
Cereals  and  a  moderate  amount  of  fats  can  now  be 
added  to  the  bill  of  fare,  but  the  fruits,  bran  or 
agar-agar,  and  parafiHn  must  be  continued. 

The  diet  must  be  made  so  bulky  and  laxative  that 
the  bowels  move  three  or  four  times  a  day.  Four 
movements  a  day  are  better  than  three.  The  stools 
should  be  odorless  or  they  may  have  a  slight  sour 
odor.  An  ammoniacal  or  putrid  odor  is  evidence 
that  the  flora  has  not  yet  been  changed,  and  the 
fruit  regimen  must  be  continued  or  repeated  after 
a  few  days.  Sometimes  several  repetitions  of  the 
regimen  at  intervals  of  a  week  or  two  are  required 
for  complete  success.  Animal  products  of  all  sorts 
must  be  avoided.  Even  milk  must  be  excluded,  as 
well  as  eggs  and  meat.     As  pointed  out  by  Tissier 


TREATMENT  OF  DISORDERS  333 

some  years  ago,  the  bacteria  which  produce  colitis 
thrive  best  upon  animal  protein. 

Another  point  of  importance  is  to  supply  the 
colon  with  carbohydrates.  Sugar  administered  by 
the  mouth  never  reaches  the  colon,  for  the  reason 
that  it  is  so  readily  absorbed  that  it  is  all  taken  up 
by  the  small  intestine.  Cooked  starch  is  digested  so 
quickly  that  it  is  also  absorbed  from  the  small  in- 
testine, only  a  mere  trace  reaching  the  colon.  The 
way  to  get  carbohydrate  into  the  colon  is  either  to 
introduce  it  by  enema,  or  to  administer  it  in  an  un- 
cooked, or  partially  cooked,  state,  so  that  it  may 
have  an  opportunity  to  reach  the  colon  before  diges- 
tion is  complete.  It  is  well  known  that  saliva  does 
not  act  upon  cooked  starch. 

Raw  starch  may  be  digested  by  the  pancreatic 
juice,  but  the  process  is  very  slow,  and  so  when 
starch  is  taken  raw  a  considerable  proportion,  ten 
to  twenty  per  zzr.t  according  to  the  writer's  observa- 
tions, may  reach  the  colon.  In  the  colon  there  are 
always  present  bacteria  capable  of  digesting  raw 
starch  and  converting  it  into  sugar.  When  sugar 
is  present,  not  only  the  ordinary  lactic  acid  forming 
bacillus  but  the  various  putrefactive  bacteria  seize 
upon  the  sugar  with  great  avidity  and  convert  it 
into  lactic  acid.  It  appears  that  even  putrefactive 
germs  are  putrefactive,  or  carnivorous,  only  when 
compelled  to  be  so  through  the  absence  of  carbo- 
hydrate in  available  form.  When  sugar  is  present, 
putrefaction  does  not  take  place.  This  important 
fact  was  pointed  out  by  Kendall  some  years  ago, 


334  COLON  HYGIENE 

and  demonstrates  that  it  is  possible  to  reform  the 
bacteria  of  the  colon,  and  this  is  much  more  easily 
accomplished  than  to  drive  out  the  various  species 
of  bacteria  v^^hich,  in  most  cases,  have  been  thor- 
oughlj^  established  in  the  intestine  for  years,  and 
occupy  every  nook  and  corner  of  the  colon;  they 
cling  so  tenaciously  to  the  territory  which  they  have 
invaded,  that  it  is  practically  impossible  to  drive 
them  out  so  completely  that  a  sufficient  number 
w^ill  not  be  left  behind  to  quickly  re-establish  them- 
selves when  favorable  conditions  develop. 

Raw  starch  may  be  introduced  in  various  ways. 
A  convenient  method  is  by  the  use  of  "brose"  (see 
page  237).  Another  excellent  plan  is  the  follow- 
ing: Pour  into  a  bowl  six  ounces  of  boiling  water. 
Rapidly  stir  in  a  heaping  tablespoonful  of  fine  oat- 
meal, or  rolled  oats,  which  has  been  passed  through 
a  vegetable  grinder.  Let  it  stand  one  side  for  five 
minutes  and  add  a  little  salt  and  eat  as  porridge. 
The  preparation  is  not  unpalatable.  If  desired,  it 
may  be  taken  as  a  beverage  with  the  addition  of  a 
little  water  or  fruit  juice. 

In  addition  to  the  above,  there  are  several  other 
highly  effective  measures  which  may  be  advantage- 
ously employed  in  the  treatment  of  colitis.  Not- 
withstanding the  free  use  of  bran  or  agar-agar  and 
paraffin,  the  colon  may  be  so  crippled  that  it  does 
not  completely  empty  itself  and  a  sufficient  amount 
of  material  is  constantly  left  behind  to  encourage 
putrefaction,  and  to  prevent  the  healing  of  the  dis- 
eased surfaces.     Examination  with  the  X-ray  shows 


TREATMENT  OF  DISORDERS  335 

in  these  cases  a  spastic,  or  contracted,  condition  of 
the  descending  or  pelvic  colon,  and  in  many  cases 
a  prolapsed  condition  of  the  pelvic  colon,  w^hich 
may  be  adherent.  In  these  cases,  the  colon  must  be 
daily  washed  out  by  means  of  an  enema  consisting 
of  two  or  three  pints  of  salt  water.  The  tempera- 
ture of  the  water  should  be  105°  to  108°.  The 
enema  should  be  repeated  several  times,  or  until  the 
water  returns  clear.  The  effectiveness  of  the  enema 
is  greatly  increased  by  thorough  massage  of  the 
colon,  especially  of  the  pelvic  colon,  with  the  patient 
in  the  knee-chest  position.  When  the  pelvic  colon 
is  distended  by  the  enema  it  may  be  manipulated 
more  effectively. 

After  the  colon  has  been  thoroughly  emptied,  an 
injection  is  made  consisting  of  a  culture  of  Bacillus 
Bulgaricus  in  whey,  to  which  has  been  added  a 
small  portion  of  well  boiled  starch  and  also  a  small 
quantity  of  malt  sugar.  By  this  means  the  colon 
is  inoculated  with  germs ;  in  other  words,  a  new 
flora  is  planted  and  supplied  with  the  material  to 
promote  its  growth  and  development,  and  to  help 
reform  the  wild  bacteria  of  the  colon  to  which  co- 
litis is  due. 

It  is  well  to  use  short  tonic  baths,  the. moist  ab- 
dominal bandage,  fomentations  and  other  applica- 
tions of  heat  to  this  region.  Light  baths,  and  meas- 
uses  of  all  sorts  which  build  up  the  general  health, 
must  supplement  the  local  measures  above  suggested. 
This  method  of  dealing  with  cases  of  colitis  has 
long  ago  passed  the  experimental  stage.     By  thor- 


336  COLON  HYGIENE  , 

ough  application  of  these  simple  means  many  hun- 
dreds of  chronic  sufferers  from  colitis  have  been  not 
only  relieved,  but  cured.  It  must  be  remembered, 
however,  that  the  measures  found  necessary  to  effect 
a  cure  of  this  distressing  ailment  must  be  adhered 
to  more  or  less  strictly  after  the  cure,  as  the  only 
certain  means  of  preventing  recurrence. 

Proctitis 

In  cases  in  which  cumulative  constipation  in- 
volves the  rectum,  infection,  here  known  as 
jproctitis,  develops  in  this  part  also.  Infection  may 
extend  from  the  pelvic  colon  into  the  rectum.  When 
the  rectum  is  involved,  the  patient  often  suffers 
from  more  or  less  constant  pain  and  uneasiness  in 
this  region;  there  may  be  frequent  desire  to  move 
the  bowels,  but  however  frequently  the  bowels  may 
be  moved,  there  will  always  be  some  feces  remain- 
ing in  the  rectum,  together  with  mucus  and,  oc- 
casionally, blood.  An  examination  of  the  rectum 
sometimes  shows  ulceration.  In  advanced  cases, 
the  mucous  membrane  is  sm.ooth  and  dry,  with 
patches  of  mucus  adhering  here  and  there,  and 
frequently  raw  surfaces  which  bleed  when  touched. 
The  conditions  are  identical  with  those  which  are 
found  in  the  bowel  higher  up.  The  point  of  junc- 
tion of  the  colon  and  the  rectum  is  a  favorite 
jeat  for  ulcerations  and  thickenings  of  the  mucous 
*iembrane. 


TREATMENT  OF  DISORDERS  337 

When  the  disease  extends  deeper  into  the  wall  of 
the  bowel,  as  it  does  sooner  or  later,  thickening  and 
rigidity  result.  By  extension  of  the  disease  through 
the  membranous  wall,  the  outer  surface  becomes 
inflamed,  and  adhesions  may  occur  between  the 
lower  bowel  and  the  bladder,  which  sometimes 
result  in  fistulae  between  the  two  viscera.  Adhesions 
may  also  occur  between  the  colon  and  small  in- 
testines and  other  parts;  the  ulcerations  may  heal 
and  form  cicatrices,  which  contract  and  produce 
obstruction.  The  lower  part  of  the  rectum  and  the 
juncture  of  the  colon  and  rectum,  the  pelvirectal 
valve,  usually  show  the  worst  effects  of  catarrhal 
colitis,  and  these  points  are  the  favorite  seat  of 
cancerous  growths.  The  long  continued  irritation 
to  which  these  parts  are  subjected  also  leads  to  the 
development  of  other  growths,  which,  together  with 
ulcerations,  as  has  been  shown  by  Mummery,  a 
very  eminent  London  specialist,  are  very  prone  to 
develop  into  cancer,  and  on  this  account,  every 
person  who  suffers  from  catarrhal  colitis,  as  shown 
by  the  presence  of  mucus  in  the  stools,  should 
submit  himself  to  a  physician  for  examination  in 
order  that  any  existing  tendency  towards  maligancy 
may  be  recognized  suflSciently  early  to  permit  of 
its  radical  treatment. 

The  treatment  of  proctitis  is  essentially  the  same 
as  that  already  outlined  for  colitis.  Change  of  the 
intestinal  flora,  frequent  bowel  movements,  daily 
cleansing  of  the  colon,  an  anti-toxic  diet,  and  the 


338  COLON  HYGIENE 

introduction  into  the  colon  of  cultures  of  lactic  acid 
forming  organisms  are  the  most  important  measures. 
Faithful  employment  of  these  measures  will  usually 
effect  a  cure. 

Muco-membranous  Colitis 

This  disease  is  probably  only  a  variet}'  of  the 
preceding.  Of  this  the  writer  has  been  convinced 
for  many  years,  although  most  authorities  still 
describe  this  malady  as  a  nervous  disorder.  The 
only  particulars  in  which  it  differs  from  catarrhal 
colitis  are: 

1.  The  fact  that  mucus  is  not  constantly  present 
in  the  stools  as  in  catarrhal  colitis. 

2.  The  presence  of  membranes  which  are  some- 
times complete  casts  of  the  bowel,  and  may  be  a 
foot  or  more  in  length. 

3.  Colic  pains. 

4.  Intermittent  occurrence  of  the  symptoms. 
These  differences  are  not  sufficient  to  characterize 

this  condition  as  a  distinct  disease.  Constipation 
is  the  predisposing  condition  which  lies  back  of  this 
disease,  as  well  as  of  catarrhal  colitis.  If  the  in- 
fection is  not  sufficiently  intense  to  produce  con- 
tinuous symptoms,  it  is  only  necessar}^  that  it  should 
be  increased  by  some  indiscretion  in  diet,  exhaustion, 
a  severe  cold,  or  some  other  factor,  to  precipitate 
an  attack.  The  casts  consist  of  coagulated  mucus, 
and  not  mucous  membrane  as  patients  often  imagine 


TREATMENT  OF  DISORDERS  339 

The  colic  pains  are  due  to  violent  contraction  of 
the  colon,  which  are  excited  by  the  accumulation 
of  gas  and  irritating  fecal  matter.  This  disease 
is  often  associated  with  chronic  affections  of  the 
pelvic  organs,  and  is  much  more  frequent  in  women 
than  in  men. 

Colitis  in  any  form  is  a  serious  condition  which 
cannot  be  safely  neglected.  Sooner  or  later  it  creates 
conditions  which  are  beyond  remedy  except  by 
surgical  means. 

Treatment 

The  treatment  of  this  condition  does  not  differ 
from  that  already  outlined  for  the  treatment  of 
colitis.  Medicinal  laxatives  of  all  sorts  must  be 
avoided,  because  these  only  serve  to  aggravate  and 
perpetuate  the  disease. 

Enlargement  of  the  Liver  and  Spleen 

Marked  enlargement  of  the  liver  and  spleen  are 
frequently  the  result  of  chronic  constipation  with 
intestinal  autointoxication.  The  constant  flooding 
of  the  liver  with  toxins  must  result  in  damage  to 
its  tissues.  Boix  showed  this  in  his  experiments 
upon  rabbits.  Some  years  ago  the  writer  en- 
countered a  case  of  enormous  enlargement  of  the 
liver,  in  which  there  had  never  been  any  use  of 
alcohol,  and  there  could  be  found  no  more  tangible 
cause  for  the  disease   than   a   chronic  constipation 


340  COLON  HYGIENE 

which  had  existed  for  many  years.  The  writer  has 
seen  many  cases  of  decided  enlargement  of  the  liver 
and  spleen,  in  which  constipation  and  autointoxica- 
tion existed  to  a  marked  degree. 

Fecal  Tumors 

When  the  obstruction  which  causes  a  delay  in 
the  movement  of  feces  through  the  colon  is 
permanent,  the  mass  of  accumulated  feces  may  at- 
tain such  a  size  as  to  be  easily  felt  through  the 
abdominal  wall.  Fecal  tumors  may  generally  be 
distinguished  from  other  tumors  by  their  doughy 
consistency,  that  is,  their  shape  may  be  moulded 
by  pressure  with  the  fingers.  Such  forms  sometimes 
disappear  suddenly  and  may  be  broken  up  by  the 
manipulation  of  the  hands,  or  softened  by  means 
of  enemas  of  warm  water  or  warm  oil.  Sometimes 
a  surgical  operation  is  necessary  for  their  removal. 

The  late  Dr.  Lawson  Tait  told  the  writer  of 
a  case  to  which  he  was  called  to  operate  for  the 
removal  of  a  large  abdominal  tumor,  which  proved 
to  be  a  tumor  of  this  sort.  On  opening  the  abdo- 
men, the  small  intestine  was  found  to  be  enormously 
distended  just  at  the  ileocecal  valve.  On  inquiry, 
it  was  found  that  the  patient,  who  was  recently  con- 
valescent from  tj'phoid  fever,  had  swallowed  rather 
rapidly  a  large  quantity  of  milk.  Suspicion  at  once 
arose  in  the  mind  of  the  surgeon  that  the  mass  might 
consist  of  undigested  curds.  With  this  idea  in  mind, 
he  carefully  manipulated  the  tumor  with  his  fingers. 


TREATMENT  OF  DISORDERS  341 

and  finally  succeeded  in  breaking  up  the  mass  to 
such  a  degree  that  it  became  possible  to  push  the  frag- 
ments through  the  ileocecal  valve,  and  thus  a  more 
serious  operation  was  avoided. 

Volvulus 

Sometimes  the  processes  which  begin  in  the  in- 
testine and  work  outward  through  the  intestinal 
wall  give  rise  to  inflammatory  changes  in  the  mem- 
branous fold  of  mesentery  to  which  the  pelvic  loop 
of  the  colon  is  attached.  As  a  result  the  mesentery 
is  gradually  shortened  until  the  ends  of  the  loop 
are  brought  close  together  and  fixed.  With  the 
colon  in  this  position,  there  is  a  great  risk  of  ob- 
struction from  the  twisting  of  the  loop,  which 
occasionally  happens,  giving  rise  to  what  is  known 
as  volvulus.  In  a  case  of  this  kind  prompt  surgical 
relief  is  very  essential.  A  short  delay  may  give 
rise  to  gangrene  of  the  intestine,  and  general 
peritonitis. 

Disorders  of  tlie  Stomach 

Although  located  at  the  other  extremity  of  the 
digestive  canal  from  the  colon,  the  stomach  is, 
nevertheless,  in  various  ways  and  to  a  profound 
degree  influenced  by  chronic  constipation.  Loss  of 
appetite  is  a  very  common  symptom  in  constipation, 
and  so  constipation  is  increased  through  the  lack 
of  the  vigorous  stimulation  given  to  the  movement 
of  the  intestine  by  the  taking  of  food  with  relish. 


342  COLON  HYGIENE 

Hyperhydrochloria,  gastritis,  and  even  ulceration 
in  the  stomach  and  duodenum  are  by  many  eminent 
medical  men  attributed  to  the  stagnation  of  the 
intestinal  contents. 

Diseases  of  the  Heart  and  Blood  Vessels 

Palpitation  of  the  heart  is  a  common  consequence 
of  an  acute  accumulation  of  feces  in  the  colon, 
probably  the  result  of  the  excessive  absorption  of 
toxins  to  which  such  accumulations  give  rise. 

Pseudo-angina  pectoris,  in  which  the  patient  suf- 
fers pain  in  the  region  of  the  heart  entirely  sim- 
ilar to  those  which  occur  in  angina  pectoris,  are 
frequently  associated  with  chronic  constipation. 
Chronic  constipation  or  the  autointoxication  result- 
ing from  it  may  be  regarded  as  a  cause  of  true  angina 
pectoris  as  well  as  of  pseudo-angina.  Arteriosclero- 
sis affecting  the  vessels  of  the  heart  has  been  clearly 
shown  by  Bouchard  and  other  authorities  to  be 
one  of  the  common  results  of  chronic  constipation, 
and  attacks  of  angina  pectoris  often  appear  among 
other  symptoms  of  the  degenerative  changes  which 
have  taken  place.  Years  ago  Boix  of  Paris  showed 
that  the  poisons  produced  by  the  colon  bacillus  are 
capable  of  producing  these  .degenerative  changes 
which  result  in  sclerosis  of  the  arteries  of  the  liver, 
spleen,  and  other  glands. 

Premature  Senility 

The  senile  appearance  of  many  persons  who  have 
long  suffered  from  chronic  constipation,  as  well  as 


TREATMENT  OF  DISORDERS  343 

the  steady  decline  of  longevity  in  countries  in  which 
constipation  is  prevalent,  is  evidence  of  the  mis- 
chievous results  of  the  constant  absorption  of  the 
poisons  produced  by  colon  germs  which  Metch- 
nikofE  regards  as  the  cause  of  old  age.  The  pig- 
mentation of  the  skin  appearing  first  about  the  eyes 
and  as  brown  spots  upon  the  hands,  the  thinning  of 
the  skin  of  the  hands  and  parchment-like  appearance 
of  the  skin  are  familiar  symptoms  of  senility  induced 
by  alimentary  toxemia.  It  is  highly  important  to 
note  that  these  senile  changes  are  not  confined  to 
the  skin.  The  changes  in  the  skin  are  only  the 
external  signs  of  similar  degenerative  changes  tak- 
ing place  in  the  bloodvessels,  liver,  kidneys,  and 
other  vital  internal  parts. 

Disease  of  the  Kidneys 

The  poisoning  resulting  in  chronic  constipation 
is  frequently  indicated  by  the  appearance  of  albumen 
and  casts  in  the  urine.  A  long  continuance  of  this 
poisoning  gives  rise  to  changes  in  the  kidney,  which 
are  commonly  known  as  Bright's  disease.  It  is  in- 
deed quite  possible  that  chronic  constipation  may  be 
one  of  the  most  important  of  all  causes  of  this 
terrible  malady.  Statistics  of  all  civilized  countries 
show  that  Bright's  disease  is  increasing  very  rapidly. 
In  the  United  States  the  number  of  persons  dying 
of  it  is  at  the  present  time  2.31  times  as  great  as 
thirty  years  ago.  In  certain  cities  the  proportion  is 
still  higher,  the  increased  mortality  rate  from  this 


344  COLON  HYGltLNE 

cause  amounting  to  164  per  cent.  The  large  use 
of  meat  in  connection  with  this  condition  of  consti- 
pation greatly  aggravates  the  evils  arising  from  this 
condition,  because  meat  not  only  affords  the  poison- 
forming  bacteria  just  the  sort  of  material  they  re- 
quire to  promote  their  growth,  but  also  introduces 
into  the  intestine  in  large  numbers  the  most  viru- 
lent forms  of  putrefactive  bacteria. 

Suppuration  of  the  kidney,  shown  by  pus  in  the 
urine  as  well  as  by  local  pains  and  other  symptoms, 
is  usually  associated  with  chronic  constipation. 
Infection  of  the  kidney  with  colon  germs  may  occur 
through  the  urinary  tract,  the  germs  travelling  by 
the  ureters  to  the  kidney,  or  direct  infection  may 
occur.  The  bacteria  which  grow  in  the  intestines, 
specially  when  their  virulence  is  increased  by  stasis 
or  stagnation,  readily  penetrate  the  walls  of  the 
intestine  and  adjacent  organs.  The  right  kidney 
lies  in  immediate  proximity  to  the  colon. 

Bacteriological  examination  of  the  urine  in  cases 
of  suppuration  of  the  kidney  often  shows  the  pres- 
ence of  colon  germs. 

Movable  Kidney 

The  right  kidney  is  so  closely  connected  with  the 
hepatic  flexure  of  the  colon  that  any  change  of 
position  of  this  portion  of  the  colon  must  have  more 
or  less  effect  upon  the  kidney.  When  the  cecum 
and   the   ascending   colon   become   overloaded,    the 


TREATMENT  OF  DISORDERS  345 

drag  upon  the  kidney  may  become  so  great  as  to 
loosen  it  from  its  moorings,  and  lead  to  floating 
kidney. 

Disease  of  the  Liver  and  Gall-Bladder 

Recent  observations  have  shown  that  when  putre- 
fying feces  accumulate  in  the  colon  great  numbers 
of  bacteria  pass  through  the  walls  of  the  intestine 
into  the  branches  of  the  portal  vein,  and  are  car- 
ried to  the  liver.  The  liver  destroys  many  of  these 
bacteria,  but  not  a  few  of  them  pass  out  in  the  bile, 
and  thus  infect  the  bile  passages  of  the  liver  and  gall- 
bladder. It  is  possible,  also,  that  infection  may 
occur  directly  from  the  intestine.  The  bacteria  may 
ascend  the  gall  ducts  to  the  gall-bladder  and  the 
liver.  Modern  research  has  shown  that  gall-stones 
are  always  due  to  bacteria,  which  are  found  in  the 
interior  of  the  gall-stones.  Persons  suffering  from 
disorders  of  the  gall-bladder,  and  from  gall-stones, 
are  always  chronic  sufferers  from  constipation  and 
alimentary  toxemia,  to  which  unquestionably  their 
liver  troubles  are  chiefly  due. 

Insomnia 

One  very  rarely  finds  a  person  suffering  from 
insomnia  who  is  not  constipated.  Not  infrequently, 
the  constipation  is  present  in  the  latent  form,  and 
its  existence  may  not  be  expected.  Examination  of 
the  stools  and  inspection  of  the  tongue  give  clear 
evidence  of  the  existence  of  stasis  in  the  colon.    The 


346  COLON  HYGIENE 

insomnia  is  due  to  the  irritation  of  the  brain  cells 
produced  by  the  poisons  with  which  the  blood 
is  saturated  through  absorption  from  the  colon. 
The  use  of  soporifics  only  secures  temporary  relief 
with  a  certainty  of  making  the  patient  worse 
through  disturbing  his  digestion,  destroying  his  appe- 
tite, and  thus  making  his  constipation  worse.  By 
relief  of  con"tipation  through  proper  diet,  and  the 
adoption  of  other  rational  measures  the  insomnia 
may  be  made  to  disappear,  and  usually  with  very 
great  promptness. 

Headache 

This  very  common  and  most  distressing  efFect  of 
chronic  constipation  is  due  to  putrefaction  poisons 
absorbed  from  the  colon,  and  constipation  quickly 
disappears  when  the  intestinal  flora  is  changed  and 
the  bowels  made  to  move  well  three  times  a  day. 
Copious  water  drinking,  especially  drinking  two  or 
three  glasses  of  hot  water  two  or  three  times  a  day 
ameliorates  the  symptom  by  aiding  the  elimination  of 
poisons.  Attacks  of  migraine  are  always  preceded 
by  an  increase  of  stasis,  that  is,  by  an  accumu- 
lation of  fecal  matters  which  throws  into  the  blood 
a  new  flood  of  indican  and  other  toxins.  By  a 
thorough  emptying  of  the  colon  through  the  use  of 
the  enema  the  attack  may  always  be  mitigated  and 
sometimes  averted.  If  the  attack  has  actually  be- 
gun, however,  the  result  is  less  satisfactory  although 


TREATMENT  OF  DISORDERS  347 

even  then  the  duration  of  the  attack  if  not  its  intens- 
ity may  be  lessened  by  emptying  the  colon  by 
repeated  enemas.  When  vomiting  or  nausea  is 
present,  the  enema  should  be  repeated  several  times 
a  day  as  a  means  of  introducing  much  needed  fluid. 
An  excellent  plan  is  to  introduce  into  the  colon  to 
be  retained  and  absorbed  half  a  pint  to  a  pint  of 
water  every  hour  or  two. 

The  excruciating  pain  of  migraine  may  be  made 
more  endurable  by  fomentations  or  alternate  hot 
and  cold  applications  to  the  painful  parts.  The 
use  of  morphia  and  other  narcotic  or  pain  retrieving 
drugs  is  most  pernicious.  The  use  of  drugs  pur- 
chases but  present  relief  at  the  expense  of  increased 
future  suffering.  Such  drugs  increase  the  consti- 
pation and  so  aggravate  the  toxemia  and  not  infre- 
quently a  drug  habit  is  formed. 

Rachitis,  Arrest  of  Growth  and  Other  Dis- 
turbances of  Nutrition  in   Infants 

The  researches  of  Combe  and  Rouget  have  clearly 
shown  the  relation  of  intestinal  intoxication  to  the 
arrested  growth  and  other  disturbances  of  nutrition 
which  are  frequently  observed  in  infants  and  young 
children  and  that  constipation  lies  at  the  foundation 
in  most  of  these  cases.  One  of  the  most  important 
of  all  the  duties  of  the  nurse  is  to  attend  carefully 
to  the  condition  of  the  infant's  bowels,  as  neglect 
in  the  first  weeks  of  infancy  may  lay  the  foundation 


348  COLON  HYGIENE 

of  troubles  which  years  of  painstaking  efforts  will 
be  required  to  relieve,  and  which  may  be  irrepar- 
able. 

Diverticulitis 

This  newly-described  disease  affects  especially 
the  colon,  and  particularly  the  pelvic  colon.  It 
consists  in  the  formation  of  small  pouches  along  the 
border  of  the  colon,  which  sometimes  increase  to  a 
considerable  size.  These  pouches  become  filled  with 
feces,  which  often  set  up  irritation  and  give  rise  to 
abscesses. 

Many  of  these  pouches  have  very  narrow  mouths 
so  that  fecal  matter  readily  accumulates  in  them. 
This  condition  involves  many  serious  dangers.  If 
the  mouth  of  a  diverticulum  becomes  closed,  the 
infectious  contents  quickly  give  rise  to  inflamma- 
tion which  may  result  in  ulcer  of  the  bowel,  abscess, 
or  adhesions  with  the  formation  of  a  tumor  mass 
and  obstruction.  When  diverticuli  are  known  to 
exist,  the  patient  should  take  care  to  keep  the  bowels 
freely  open  by  a  very  laxative  diet  and  the  use  of 
Russian  paraffin  oil. 

Diverticulitis  is  caused  by  injury  to  the  intestinal 
wall  produced  by  colitis  followed  by  overdistention 
of  the  bowel  by  accumulation  of  fecal  matters. 

Each  diverticulum  involves  exactly  the  same  dan- 
gers which  are  connected  with  a  chronically  inflamed 
appendix.     ^ 

Diverticulitis  may  cause  obstruction  of  the  bowels, 
both  by  giving  rise  to  adhesions  and  by  causing  thick- 


TREATMENT  OF  DISORDERS  349 

ening  of  the  walls  of  the  intestine,  and  so  gradually 
narrowing  its  lumen  until  complete  obstruction 
occurs.  This  condition  is  sometimes  mistaken  for 
cancer. 

Cancer 

The  discoveries  of  Ross  respecting  the  cause  of 
cancer  show  very  clearly  the  reason  for  the  special 
frequency  of  cancer  in  the  pelvic  colon  and  the 
rectum.  According  to  Ross,  cancer  is  due  to  an 
abnormal  stimulation  of  the  processes  of  normal 
cell  growth.  He  has  shown  by  elaborate  laboratory 
researches  that  cholin  and  cadaverin,  two  of  the 
products  of  the  putrefaction  of  flesh  or  protein,  are 
powerful  augmenters  of  cell  action,  and  in  recent 
experiments  he  has  been  able  by  these  poisons  to 
produce  in  guinea  pigs  growths  which  have  all  the 
characteristics  of  cancer.  Certainly  no  part  of  the 
body  is  more  exposed  to  the  influence  of  these  putre- 
factive products  than  is  the  lower  bowel.  It  is 
evident,  then,  that  this  portion  of  the  body  should 
receive  prompt  attention  on  the  occurrence  of  the 
slightest  symptoms  of  disease,  and  that  as  a  protec- 
tive measure  putrefaction  of  the  feces  should  be 
prevented  by  proper  regulation  of  diet  and  of  the 
bowel  movement. 

Tuberculosis  of  the  Bowels 

Intestinal  tuberculosis  appears  to  be  increasing. 
That  this  should  be  the  case  is  not  surprising,  in 
view  of  the  fact  that  constipation  is  becoming  more 


350  COLON  HYGIENE 

and  more  prevalent  each  year.  The  contact  of 
poisonous  fecal  matters  with  the  mucous  membrane 
lowers  its  resistance  and  renders  it  susceptible  to  the 
infectious  influence  of  the  tubercle  germ.  All  forms 
of  tuberculosis,  as  the  history  of  cases  shows,  are 
almost  invariably  preceded  by  chronic  constipation 
for  a  prolonged  period. 

Backache 

Aside  from  symptoms  which  relate  to  the  rectum, 
backache  is  perhaps  the  most  common  of  all  local 
symptoms  arising  from  constipation.  In  women 
this  symptom  is  usually  attributed  to  disease  of  the 
womb  or  ovaries.  It  is  safe  to  say  that  in  by  far 
the  larger  number  of  cases  the  pain  is  due  not  to 
disease  of  the  organs  peculiar  to  women,  but  to  a 
diseased  condition  of  the  colon,  set  up  by  long  con- 
tinued contact  with  putrefying  fecal  matters.  In 
many  cases  tender  points  can  be  felt  by  deep  pressure 
along  the  iliac  or  the  descending  colon.  Sometimes 
the  pelvic  colon  may  be  located.  By  the  aid  of  the 
X-ray  and  the  fluoroscope  it  is  possible  to  locate  and 
make  pressure  upon  every  part  of  the  colon,  as  well 
as  to  note  its  form  and  size,  and  thus  the  presence  of 
disease  may  now  easily  be  located  when  present. 

The  pain  is  reflex  in  character,  and  may  often  be 
produced  by  pressure  upon  a  contracted  and  tender 
part  of  the  colon.  Pains  over  the  sacrum  are  quite 
as  often  due  to  disease  of  the  rectum  as  to  disease 
of  the  uterus  or  ovaries.     As  constipation  is  so  con- 


TREATMENT  OF  DISORDERS  351 

stantly  associated  with  disease  of  the  pelvic  organs, 
it  is  a  question  of  interest  whether  the  pain  usually 
attributed  to  pelvic  disease,  when  this  is  present, 
may  not  in  many  cases  be  really  due  to  disease  of  the 
colon  or  rectum.  Tender  spots  in  the  lower  part 
of  the  back  are  usually  due  to  the  same  cause,  and 
only  rarely  indicate  disease  of  the  spine. 

The  congestion  of  the  abdominal  organs  which 
results  from  chronic  constipation  is  the  cause  of  a 
great  variety  of  reflex  pains  in  the  back  and  sides. 
Coldness,  numbness,  prickling  and  creeping  sensa- 
tions, and  points  of  tenderness  in  the  abdomen,  a 
sense  of  weight,  dragging  and  pressure,  are  only  a 
few  of  the  distressing  symptoms  which  arise  from 
visceral  congestion  due  to  the  absorption  of  toxins 
from  the  intestinal  tract,  and  the  infection  of  the 
intestinal  mucous  membrane  resulting  from  chronic 
constipation. 

Exophthalmic  Goitre 

This  serious  disorder,  which  is  becoming  con- 
stantly more  common,  is  unquestionably  due  to 
chronic  intestinal  poisoning,  and  hence  may  be  the 
result  of  constipation,  which  in  some  form  is  always 
present  in  cases  of  chronic  intestinal  autointoxication. 
To  treat  this  malady  simply  by  removal  of  a  part  of 
the  thyroid  gland  by  a  surgical  operation,  or  by 
partial  destruction  of  the  gland  by  the  X-ray  with- 
out giving  attention  to  its  cause,  is  certainly  irra- 


352  COLON  HYGIENE 

tional,  since  the  enlargement  and  activity  are  the 
effects,  no  doubt,  the  absorption  of  toxins  from  the 
intestinal  canal.  The  gland  enlarges  because  of  the 
extraordinary  amount  of  work  demanded  of  it,  its 
special  function  in  the  body  being  to  aid  in  the 
destruction  of  poisons,  especially  those  developed  in 
the  intestine  by  the  decomposition  of  protein.  Ani- 
mals whose  thyroids  have  been  removed  soon  develop 
convulsions  and  die  when  fed  on  a  meat  diet,  but 
thrive  indefinitely  on  a  diet  which  excludes  meat. 

Myxedema 

A  disease  which  is  the  antithesis  of  exophthalmic 
goitre,  myxedema,  is  really  due  to  the  same  cause. 
The  thyroid  gland  becomes  worn  out  by  excessive 
work,  and  its  function  is  lost.  In  consequence,  the 
whole  body  suffers  from  peculiar  degenerative 
changes.  The  skin  and  hair  become  dry,  pale  and 
sodden  in  appearance,  the  speech  is  thick,  the  expres- 
sion is  peculiar  and  characteristic,  and  the  intellect  is 
dulled.  The  cause  of  this  peculiar  disease  was 
wholly  a  mystery  until  the  function  of  the  thyroid 
was  discovered.  It  is  now  known  to  be  due  to  the 
failure  of  this  important  gland  to  do  its  work,  as 
the  result  of  degeneration,  which  is  in  most  cases 
the  result  of  the  excessive  work  imposed  upon  it  by 
the  automtoxication  induced  by  a  high  protein  diet: 
that  is,  by  the  free  use  of  meat  and  eggs,  especially 
when  associated  with  constipation. 


TREATMENT  OF  DISORDERS  353 

Hypothyroidism,  incipient  myxedema,  is  a  very 
common  malady.  The  thyroid  is  less  active  than 
it  should  be  though  its  function  is  not  wholly  lost. 
Dryness  of  the  hair,  falling  of  the  hair,  and  dryness 
of  the  skin  are  common  symptoms  of  this  condition, 
seen  associated  with  chronic  constipation,  and  the 
natural  result  of  long  overwork  of  the  thyroid  in 
destroying  colon  poisons. 

Chronic  Rheumatism  and  Rheumatic  Gout 
(  Osteo- Arthritis  ) 

Both  these  diseases  are  closely  associated  with 
constipation  and  alimentary  toxemia.  Herter  showed 
that  certain  putrefactive  organisms  are  always  pres- 
ent in  great  numbers  in  the  stools  of  persons  suffer- 
ing from  rheumatic  gout.  The  experience  of  many 
physicians  has  shown  that  great  improvement  often 
follows  the  adoption  of  a  low  v"""  n  diet  in  these 
cases;  and  the  benefit  derived  from  securing 
increased  activity  of  the  bowels  has  made  many  a 
mineral  spring  famous  as  a  cure-all  for  rheumatics. 

The  writer  has  seen  hundreds  of  chronic  sufferers 
from  these  maladies  greatly  relieved  and  many 
cured  by  a  low  protein  diet  and  the  restoration  of 
normal  colon  activity. 

Pigmentation  of  the  Skin  and  Skin  Diseases 

When  meat  and  eggs  are  eaten  freely,  accord- 
ing to  Combe,  there  may  be  produced  in  the  intestine 


354  COLON  HYGIENE 

a  large  amount  of  a  brown  poisonous  coloring  sub- 
stance, "brenzcatchin,"  to  destroy  which  is  one  of 
the  functions  of  the  suprarenal  capsules.  When 
these  glands  become  defective,  through  overwork, 
this  substance  accumulates  and,  being  deposited  in 
the  skin,  gives  rise  to  dinginess  of  the  complexion, 
brown  circles  around  the  eyes,  so-called  "liver 
patches"  on  the  face  and  other  parts,  brown  spots 
upon  the  hands,  and  a  deepening  of  the  color  of 
parts  of  the  skin  which  are  normally  pigmented, 
as  the  axillary  regions,  groins,  and  in  many  patients 
a  line  down  the  center  of  the  back. 

This  pigmentation  is  commonly  seen  in  aged 
persons,  in  whom  as  in  others  its  cause  is  the  consti- 
pation which  is  i.isually  associated  with  old  age.  The 
Same  pigmentation  is  sometimes  seen  in  young  per- 
sons, and  even  in  infants,  as  the  result  of  intense 
poisoning  from  intestial  putrefaction.  When  an 
antitoxic  diet  is  aaopted,  and  the  bowels  are  made 
to  act  normally,  the  pigmentation  disappears  with 
remarkable  quickness.  Dr.  Lane  of  London  has 
demonstrated  the  connection  between  this  abnormal 
pigmentation  and  putrefaction  in  the  colon,  by 
removing  the  colon.  He  states  that  the  worst  cases 
show  a  surprising  change  for  the  better  in  a  few 
days,  and  the  pigmentation  wholly  disappears  within 
a  few  weeks.  Cases  seen  by  the  writer  in  a  London 
hospital  seemed  to  verify  this  claim,  which  is  also 
supported  by  the  results  of  securing  frequent  daily 
movements   in  very  chronic   cases  of   constipation. 


TREATMENT  OF  DISORDERS  355 

Eczema 

Eczema,  one  of  the  most  common  and  most  dis- 
tressing of  skin  maladies,  has  long  been  known  by 
skin  specialists  to  be  caused  by  constipation.  Doctor 
Bulkley,  the  eminent  skin  specialist  of  New  York 
City,  has  within  the  last  thirty  years  many  times 
called  attention  to  the  fact  that  eczema  is  encour- 
aged by  the  use  of  flesh  food,  and  that  most  chronic 
cases  are  curable  by  strict  adherence  to  a  non-flesh 
dietary,  even  when  all  other  measures  have  failed 
to  give  relief. 

A  most  distressing  form  of  this  disease  is  ec- 
zema of  the  anal  region,  one  of  the  frequent  re- 
sults of  constipation.  This  annoying  ailment  usu- 
ally disappears  very  soon  when  the  bowels  are  made 
to  move  three  times  a  day,  and  meat  is  excluded 
from  the  diet. 

Temporary  relief  from  the  horrible  itching  of 
eczema  may  be  obtained  in  many  cases  by  bathing  the 
parts  Vv^ith  very  hot  water  (120°  F.),  or  by  exposing 
them  to  hot  steam.  Then  apply  an  unguent,  con- 
sisting of  the  following:  lanolin  2  drams,  borogly- 
ceride  1  dram,  cold  cream  6  drams.  This  method 
usually  succeeds  especially  well  in  old  cases  in  which 
the  skin  is  dry  or  scaly.  The  eruption  usually  dis- 
appears ver}^  quickly  after  a  proper  X-ray  applica- 
tion. The  actinic  ray  is  sometim-cs  more  effective. 
The  affected  parts  should  be  constantly  and  very 
carefully  protected. 


356  COLON  HYGIENE 

Psoriasis 

This  form  of  skin  disease,  usually  more  obstinate 
though  less  distressing  than  eczema,  is  generally 
incurable  without  the  adoption  of  a  fleshless  diet  and 
restoration  of  the  normal  function  of  the  colon. 
In  many  cases  nothing  else  is  needed  to  effect  a 
permanent  cure.  A  few  applications  of  the  actinic 
rays  by  means  of  the  arc  light  or  the  "mercury  light" 
will  generally  cause  the  eruptions  to  disappear. 
Apply  the  skin  cream  given  on  previous  page. 

Itching  Skin  without  Eruption 

Many  constipated  persons,  especially  old  persons, 
suffer  from  intense  itching  and  burning  of  the  skin, 
especially  of  the  back  and  other  parts  of  the  arms 
and  legs.  The  affection  is  generally  worse  in  cold 
weather  and  when  hard  water  is  used  for  baths.  A 
soap  and  water  bath  is  generally  followed  by  an 
increase  of  the  itching.  If  the  skin  is  scratched,  an 
eruption  resembling  eczema  appears. 

Besides  combatting  the  constipation  nearly  always 
present,  bathe  the  parts  with  water  as  hot  as  can  be 
borne  (120°  F.)  several  times  daily.  Avoid  rub- 
bing. After  bathing,  apply  skin  cream  freely.  The 
cream  should  be  applied  to  the  whole  surface  of  the 
body  after  bathing  and  daily  or  even  twice  a  day. 
If  necessary  to  completely  relieve  the  itching,  men- 
thol may  be  added  to  the  cream  in  the  proportion 
of  ten  grains  to  the  ounce. 


TREATMENT  OF  DISORDERS  357 

Vertigo 

This  unpleasant  symptom  is  a  very  common  result 
of  constipation.  Vertigo  is  a  common  symptom  in 
cases  of  arteriosclerosis  caused  by  constipation,  and 
sometimes  results  from  irritation  produced  by  the 
presence  of  feces  in  the  rectum.  In  certain  nervous 
persons,  vertigo,  faintness  or  exhaustion  are  some- 
times experienced  when  the  bow^els  are  evacuated  by 
a  saline  laxative  or  by  an  enema.  The  cause  of  this 
is  doubtless  the  absorption  of  poisons  brought  into 
solution  by  the  large  amount  of  fluid  present  in  the 
intestine.  So  long  as  the  feces  are  hard,  little  absorp- 
tion can  take  place.  But  when  they  become  semi- 
fluid, the  poisons  present  are  brought  into  solution 
and  are  also  made  to  come  in  contact  with  the 
mucous  membrane,  so  that  rapid  absorption  occurs. 
In  some  instances,  the  prostration  is  such  that  recov- 
ery does  not  take  place  for  several  hours.  These  are 
probably  cases  in  which  the  liver  and  kidneys  are 
crippled  as  the  result  of  long-standing  disease. 

Dr.  Case  has  observed  that  unpleasant  symptoms 
immediately  following  an  enema  are  connected  with 
the  entrance  of  the  injected  liquid  into  the  small 
intestine  through  an  incompetent  ileocecal  valve. 
This  is  an  interesting  observation.  It  suggests  that 
vertigo  at  other  times  may  be  due  to  refluxed  ma- 
terial from  the  colon,  due  to  antiperistaltic  action  of 
the  colon.  The  wretched  feeling  which  many 
neurasthenics   experience   in   the   morning   may   be 


358  COLON  HYGIENE 

due  to  the  same  cause.  Case  has  observed  that 
although  the  small  intestine  may  be  entirely  empty 
at  night,  in  the  morning  several  feet  of  the  intestine 
may  be  filled  with  fecal  matters  which  have  returned 
from  the  colon  through  an  incompetent  ileocecal 
valve. 

Disorders  of  the  Urinary  and  Generative 
Organs 

Urinary  troubles  in  both  men  and  women,  as  well 
as  in  children,  are  often  traceable  to  constipation. 
Very  foul-smelling  urine  often  owes  its  unnatural 
©dor  to  the  presence  of  putrefaction  poisons  absorbed 
from  the  intestine. 

Both  inability  to  urinate  and  a  frequent  desire  to 
urinate  may  result  from  the  accumulation  of  feces 
in  the  rectum.  In  children  the  escape  of  urine  dur- 
ing sleep  is  often  due  to  constipation. 

Prolapse  and  retroversion  of  the  uterus  is  a  com- 
mon result  of  the  straining  necessitated  by  constipa- 
tion in  women  and  girls. 

Dysmenorrhoea,  leucorrhoea,  and  a  varicose  con- 
dition of  the  broad  ligaments,  which  is  accompanied 
by  much  pain  and  discomfort,  may  result  from  the 
pressure  of  feces  in  the  rectum  and  lower  colon. 
Nocturnal  seminal  losses  and  an  abnormal  irritabil- 
ity of  the  parts,  causing  erection  and  also  neuralgic 
pains  in  the  testicles,  and  varicose  veins,  may  result 
from  the  congestion  caused  by  the  pressure  of  feces 
in  the  rectum  and  lower  colon. 


TREATMENT  OF  DISORDERS  359 

Fecal  Fever 

Accumulation  of  feces  in  the  colon  is  a  frequent 
cause  of  attacks  of  fever  which  so  much  resemble 
malarial  paroxysms  that  they  are  usually  treated  by 
the  administration  of  quinine.  There  is  often  a 
distinct  chill,  followed  by  fever  and  sweating.  The 
tongue  is  coated,  the  breath  bad,  and  there  is  much 
headache,  and  sometimes  vomiting.  The  fever  may 
last  several  days,  but  disappears  quickly  when  the 
bowels  have  been  thoroughly  evacuated. 

These  attacks  are  very  common  in  persons  who 
are  subject  to  colitis,  and  much  mucus  is  often  dis- 
charged when  the  bowels  are  cleared  out. 

Abdominal  surgeons  have  constant  occasion  to 
note  the  effect  of  fecal  accumulations  in  raising  the 
temperature.  A  rise  of  temperature  after  operation 
is  more  often  due  to  this  cause  than  to  any  other. 
This  fact  led  to  the  practice  of  thoroughly  evacuat- 
ing the  bowels  before  operation,  and  early  moving 
them  afterwards,  an  innovation  introduced  by  the 
late  Dr.  Lawson  Tait,  and  which  has  been  the  means 
of  saving  more  lives  than  any  other  modern  improve- 
ment in  surgery,  except  aseptic  technic  in  operation. 

Neglect  to  secure  complete  and  regular  evacuation 
of  the  bowels  is  a  frequent  cause  of  rise  of  tempera- 
ture after  confinement  and  in  convalescence  from 
acute  illness.  Accumulation  of  feces  not  infre- 
quently occurs  when  the  bowels  move  daily,  and 
even  when  the  bowels  are  quite  loose,  as  shown  by 


360  COLON  HYGIENE 

the  immense  quantities  of  loathsome  material  which 
may  be  washed  out  by  means  of  a  thorough  enema. 
The  writer  recalls  a  case  in  which  a  woman  who 
had  very  loose  movements  for  two  or  three  weeks 
was  found  to  have  an  enormous  mass  of  hardened 
fecal  matter  in  the  rectum,  and  a  very  great  accumu- 
lation of  feces  in  the  lower  colon. 

Bed  patients  should  always  be  made  to  sit  up 
when  moving  the  bowels  or  urinating,  when  this  is 
at  all  possible,  so  as  to  secure  complete  evacuation  of 
the  urine  and  feces.  In  most  cases  this  may  be  done 
without  injury  after  the  second  day.  The  same 
remark  applies  with  special  interest  to  cases  of  con- 
finement. There  is  so  often  an  accumulation  of  feces 
in  the  colon  in  pregnancy,  especially  within  the  last 
two  or  three  weeks  before  confinement,  that  it  is 
highly  important  to  give  the  matter  prompt  atten- 
tion at  once  after  the  child  is  born,  as  well  as  before 
confinement.  Very  often  a  great  quantity  of  putre- 
fying material  will  be  removed,  the  retention  of 
which  may  give  rise  to  autointoxication  with  fever 
and  even  worse  symptoms. 

Flatulency 

This  symptom  may  result  either  from  the  exces- 
sive formation  of  gas  in  the  intestine,  or  from  the 
accumulation  of  gas.  A  certain  amount  of  gas  is 
natural.  The  presence  of  gas  in  the  intestine  is 
an  aid  to  peristalsis.  This  is  especially  true  of 
the  large  intestine. 


TREATMENT  OF  DISORDERS  361 

Excessive  formation  of  gas  occurs  through 
the  action  of  bacteria  upon  the  food  stuifs.  Gas 
is  most  readily  formed  from  cooked  starch  or  sugar, 
but  may  be  formed  from  cellulose  and  from  pro- 
tein. Odorless  gas  is  usually  formed  from  starch 
or  sugar,  inflammable  gas  from  cellulose,  and  gas 
having  a  foul  odor  from  protein.  These  different 
elements  of  the  food  are  acted  upon  by  different 
species  of  bacteria,  so  that  the  character  of  the  gas 
formed  in  the  intestine  becomes  something  of  an 
index  to  the  sort  of  bacteria  present.  Bacteria 
vrhich  act  upon  starch,  sugar  and  cellulose  are  com- 
paratively harmless  while  the  presence  of  foul 
smelling  gases  indicates  the  presence  of  putrefaction 
and  the  pernicious  bacteria  and  the  virulent  poisons 
which  are  always  present  in  this  condition. 

The  formation  of  gas  in  excess  is  due  primarily 
not  so  much  to  the  excessive  use  of  starchy  food,  as 
many  persons  suppose,  but  to  stasis  or  stagnation 
of  the  food.  Bouchard  showed  long  ago  that  if  the 
foodstuffs  remain  in  one  part  of  the  alimentary 
canal,  even  in  the  stomach,  fermentation  and  other 
bacterial  changes  take  place. 

An  important  remedy  for  flatulence,  then,  is  in- 
creased intestinal  activity.  When  the  gas  is  confined 
to  the  colon  an  enema,  either  warm  or  cool,  will 
usually  secure  relief;  for  permanent  relief  the 
causes  of  the  constipation  must  be  removed  by  sys- 
tematic treatment. 

Flatulence  which  is  not  relieved  by  emptying  the 


362  COLON  HYGIENE 

colon  is  due  to  incompetency  of  the  ileocecal  valve. 
The  absence  of  the  check  valve  at  tlie  junction  of 
the  small  intestine  with  the  colon  permits  the  gas 
to  pass  back  into  the  small  intestine.  This  condition 
is  generally  greatly  mitigated  by  increased  activity 
of  the  bowels;  a  radical  cure  may  be  accomplished 
by  repairs  of  the  ileocecal  valve. 

Flatulence  may  become  dangerous  in  cases  of  high 
blood  pressure  with  degeneration  of  the  blood  ves- 
sels. The  great  accumulation  of  gas  in  the  intestines 
forces  the  blood  out  of  the  abdominal  vessels  into 
the  general  circulation,  and  so  raises  the  blood 
pressure.  If  the  blood  pressure  is  already  high,  and 
the  blood  vessels  seriously  weakened,  the  rise  of 
pressure  may  be  sufficient  to  cause  a  rupture  and 
apoplexy  with  paralysis,  if  the  rupture  occurs  in  the 
brain. 

The  wet  girdle  or  moist  abdominal  bandage  is 
often  found  a  most  efficient  means  of  combating 
flatulence.  The  bandage  must  be  kept  moist,  and 
should  not  be  too  warmly  covered.  The  mackintosh 
cover  must  be  omitted,  the  purpose  being  to  promote 
evaporation  and  thus  maintain  a  mild  stimulant 
action  upon  the  intestine.  The  bandage  will  dry 
out  in  three  or  four  hours,  when  it  should  be 
renewed.  It  may  be  worn  with  advantage 
both  night  and  day.  The  bandage  must  be  changed 
or  boiled  daily  to  avoid  producing  skin  infection. 

Flatulence  in  the  colon  always  means  stasis,  that 
is,  delayed  feces  which  need  removal.     Persons  who 


TREATMENT    OF    DISORDERS  363 

have  been  accustomed  to  a  hearty  meat  diet  some- 
times suffer  considerably  from  flatulence  when  a 
change  is  made  from  meat  to  vegetables,  but  this 
should  not  be  considered  as  a  need  to  return  to  a 
highly  nitrogenous  diet.  After  a  short  time  the 
activity  of  the  bowels  will  be  increased  to  such  a 
degree  that  the  constipation  will  be  overcome,  and 
the  flatulence  will  disappear.  In  cases  in  which  the 
free  use  of  cereals  or  starch  food  is  accompanied  by 
acidity  of  the  stomach  or  heartburn  soon  after  eating, 
the  difficulty  may  be  relieved  by  increasing  the 
amount  of  fat  taken  with  the  meals.  Usually  one 
or  two  tablespoonsful  of  olive  oil  taken  at  the  be- 
ginning of  the  meal  will  cause  the  disappearance 
of  this  unpleasant  symptom. 

Foul  Tongue  and  Bad  Breath 

These  common  conditions  are  more  often  due  to 
constipation  than  to  neglect  of  the  mouth.  A  high 
protein  diet,  that  is  the  free  use  of  eggs  and  meats, 
together  with  constipation  even  in  very  mild  degree, 
will  cause  coating  of  the  tongue  and  a  fecal  odor 
of  the  breath.  The  general  low  resistance  caused 
by  chronic  toxemia  destroys  the  ability  of  the  saliva 
to  prevent  the  growth  of  germs  in  the  mouth  and 
the  result  is  coating  of  the  tongue,  ulceration  of  the 
gums  and  decay  of  the  teeth. 

The  cure  is  not  to  be  found  in  dentifrices,  lotions, 
tooth  brushes  or  dental  procedures,  "mouth  treat- 


364  COLON  HYGIENE 

ment,"  etc.,  but  in  removal  of  the  cause  by 
draining  the  bowels  through  diet  and  other 
measure,  to  move  thoroughly  three  times  daily.  Of 
course  the  toilet  of  the  mouth  and  "mouth  treat- 
ment" by  a  skillful  dental  surgeon  must  not  be 
neglected. 

A  diet  consisting  exclusively  of  wheat  bran  and 
fruit,  preferably  apples  and  oranges,  continued  for 
three  or  four  days  will  rapidly  clear  the  tongue  and 
sweaten  the  breath  in  ordinary  cases.  Half  a  pound 
of  sterilized  bran  should  be  eaten  daily  and  apples 
may  be  eaten  in  any  quantity  which  does  not  cause 
inconvenience.  Twelve  to  sixteen  apples  taken  at 
four  meals  will  usually  be  found  sufficient.  The 
fruit  must  be  eaten  raw  and  should  be  well  chewed. 
One  or  two  apples  or  other  fruit  may  be  eaten 
whenever  a  craving  for  food  is  felt.  Fruit  imposes 
little  or  no  labor  upon  the  digesive  organs.  Berries, 
grapes,  peaches,  oranges,  melons,  tomatoes,  lettuce 
cucumbers  and  celery  may  be  added  to  the  bill  of 
fare  if  desired.  The  greater  the  bulk  and  the  less 
the  actual  food  value  represented  in  the  food  the 
better. 

The  addition  of  bran  is  necessary  for  the  reason 
that  the  tender  cellulose  of  fruit  is  often  almost 
completely  digested  and  so  furnishes  little  residue. 

The  "milk  regimen"  conducted  according  to  the 
author's  method  (see  pages  188-190),  for  one  to 
two  weeks  rarely  fails  to  clear  the  tongue  and  to 
remove  the  foul  odor  of  the  breath. 


TREATMENT    OF    DISORDERS  365- 

Hemorrhoids 

The  pain  and  inconvenience  from  hemorrhoids 
is  usually  the  result  of  infection.  The  distended 
veins  do  little  harm  unless  inflamed.  The  infection 
results  from  the  retention  of  fecal  matter  in  the 
folds  of  the  mucous  membrane.  Straining  at  stool 
distends  the  veins  and  cracks  the  mucous  membrane, 
thus  opening  up  channels  for  infection.  Abrasions 
are  also  often  produced  by  rough  toilet  paper  and 
by  lack  of  care  in  the  insertion  of  the  enema  tube. 
Thorough  cleansing  of  the  parts  with  water  after 
bowel  movement  is  an  excellent  preventive  measure. 
This  is  the  universal  custom  in  India  and  is  certainly 
more  sanitary  if  less  convenient  than  the  method 
in  universal  use  in  western  countries.  The  use  of 
an  antiseptic  suppository  after  each  bov/el  move- 
ment is  a  most  useful  precaution.  Suppositories 
made  of  cocoa  butter  and  containing  two  grains 
each  of  tannic  acid  are  most  excellent  for  this 
purpose. 

When  the  bowels  move  freely  three  or  four  times 
a  day  hemorrhoids  are  rarely  troublesome,  at  least 
when  the  precautions  above  recommended  are  em- 
ployed. In  many  cases  they  apparently  disappear. 
When  persistent  however,  they  should  be  removed. 
This  may  be  done  with  perfect  safety  and  with 
so  little  inconvenience  that  no  one  who  suffers  from 
hemorrhoids  should  hesitate  to  have  them  removed. 
Chronic  irritation  is  an  invitation  to  cancer. 


366  COLON  HYGIENE 

Anal  Fissure  or  Ulcer 

This  painful  affection  most  generally  follows 
hemorrhoids.  If  it  does  not  speedily  disappear 
when  the  bowels  become  regular,  resort  to  operation 
is  necessary.  Operation  is  also  indicated  when  the 
ulcer  renders  defecation  painful  and  thus  interferes 
with  regular  bowel  action,  which  is  most  generally 
the  case. 

The  operation  need  not  be  dreaded.  The 
modern  methods  of  dealing  with  surgical  cases  of 
this  sort  are  entirely  safe  and  nearly  painless. 

Anal  itching 

This  is  usually  a  form  of  eczema  which  is  kept 
up  by  an  irritating  discharge  from  the  rectum.  The 
measures  recommended  for  eczema  will  effect  a 
speedy  cure  after  the  bowels  have  been  regulated 
and  the  rectal  irritation  or  proctitis  has  been  cured, 

Rectal  Prolapse 

In  cases  of  prolapse  of  the  rectum  frequent 
movements  of  the  bowels  are  necessarily  avoided  on 
account  of  the  inconvenience  involved.  Such  cases 
may  be  cured  by  a  simple  and  safe  surgical  pro- 
cedure. Such  an  operation  should  be  the  first  step 
in  the  effort  to  cure  the  chronic  constipation  present 
After  the  operation,  the  free  use  of  bran  and  paraffin 
at  each  meal  will  prove  efficient. 


TREATMENT    OF    DISORDERS  367 

Anal  Incontinence 

Persons  whose  anal  sphincters  have  been  para- 
lyzed by  disease  or  by  careless  surgery  often  keep 
the  bowels  constipated  to  avoid  annoyance  from  in- 
continence. In  such  cases  it  is  of  course  necessary 
first  of  all  to  remedy  the  anal  defect.  This  may 
usually  be  done  by  a  skillful  surgeon  and  the  opera- 
tion is  attended  by  no  serious  risk. 

Anal  Spasm 

Undue  contraction  of  the  anal  sphincter  is 
generally  associated  with  fissure,  hemorrhoids  or 
rectal  irritation.  If  not  speedily  relieved  by  removal 
of  the  source  of  irritation  the  operation  of  stretching 
the  sphincter  is  necessary.  Excessive  tension  of  the 
sphincter  appears  to  be  sometimes  present  without 
evidence  of  local  irritation. 

Abdominal  Tenderness 

Very  hot  fomentations  applied  two  or  three  times 
a  day  for  ten  or  fifteen  minutes  are  almost  a 
sovereign  remedy  for  the  abdominal  tenderness 
usually  found  in  chronically  constipated  persons, 
especially  when  colitis  is  present.  The  moist  ab- 
dominal bandage  used  at  night  with  a  mackintosh 
cover  is  a  very  old-fashioned  and  still  unrivalled 
remedy  for  tenderness,  soreness  and  ill-defined  pain 
in  the  abdomen.     These   remedies  are  more  than 


368  COLON  HYGIENE 

merely  paliative,  but  of  course  are  not  in  themselves 
curative  unless  the  constipation  which  gives  rise  to 
the  congestion  of  the  sympathetic  nerve  centers,  to 
which  the  pain  is  due,  is  also  cured  by  use  of  the 
proper  means. 

Colic  Pains 

Apply  very  hot  fomentations  to  the  abdomen  and 
administer  a  hot  enema.  Repeat  the  applications 
both  of  the  fomentations  and  of  the  hot  enema  until 
the  pain  ceases  as  it  soon  will  do.  Heat  is  a  most 
excellent  antidote  for  pain.  It  also  relaxes  muscular 
spasm;  it  is  thus  a  most  appropriate  remedy  for 
intestinal  colic. 

"Kinks" 

So  much  is  being  said  about  "kinks"  in  current 
medical  literature  it  is  not  remarkable  that  the  laity 
should  begin  to  take  an  interest  in  the  subject.  The 
writer's  chief  purpose  in  mentioning  this  subject 
here  is  to  emphasize  the  fact  that  "kinks"  are  of 
far  less  consequence  than  was  at  first  supposed. 
X-ray  evidence  has  demonstrated  that  kinks  and 
folds  in  the  colon  are  seriously  obstructive  only  in 
very  rare  cases.  To  advise  a  surgical  operation 
simply  because  the  X-ray  shows  a  "kink"  or  fold 
in  the  transverse  colon  or  a  very  pronounced  pro- 
lapse is  most  improper.  It  has  been  proved  that 
the  so-called  "Lane's  kink"  of  the  terminal  ileum 


TREATMENT    OF    DISORDERS  369 

is  seldom  a  source  of  trouble  and  very  rarely  re- 
quires surgical  interference.  By  the  adoption  of 
an  atoxic  diet  from  which  all  animal  protein  is 
excluded  and  by  the  employment  of  the  necessary 
measures  for  securing  three  bowel  movements  daily 
the  troubles  supposed  to  arise  from  "kinks"  rarely 
fail  to  disappear;  and  without  the  adoption  of  these 
measures  surgery  affords  only  temporary  relief, 
sometimes  not  even  that,  as  a  return  for  the  very 
great  risk  to  life  and  the  severe  suffering  and  shock 
involved  in  such  operations  as  "short  circuiting" 
and  removal  of  the  colon. 


Bowel  Habits  of  Uncivilized  Man 

Civilized  human  beings  have  departed  so  far  from 
natural  primitive  modes  of  life,  and  have  adopted 
so  many  unphysiologic  practices,  that  it  is  quite 
impossible  from  the  conventional  usages  of  civilized 
people,  to  form  any  just  conclusion  of  what  are  nat- 
ural or  biologic  modes  of  life  for  human  beings. 
This  is  particularly  true  of  customs  and  habits  in  re- 
lation to  human  alimentation.  From  a  study  of  the 
modern  hotel  bill  of  fare  one  could  not  possibly 
obtain  even  a  suggestion  of  man's  primitive  and 
biologic  diet.  The  natural  conclusion  would  be 
that  man  is  a  universal  feeder,  since  the  average 
hotel  menu  presents  practically  everything  that  any 
animal  eats;  but  biology  teaches  us  that  man  is 
naturally  frugivorous,  and  science  offers  no  reason 
why  he  should  have  departed  from  his  original  bill 
of  fare,  to  which  his  nearest  relatives,  the  anthro- 
poid apes,  the  chimpanzee,  the  orangoutang  and  the 
gorilla,  living  in  their  native  forests,  still  scrup- 
ulously adhere. 

Man  has  not  only  developed  wrong  habits  in 
relation  to  the  kind  of  food  he  eats,  but  has  become 
unbiologic  in  almost  every  phase  of  his  daily  life. 
Constipation  is  simply  one  of  the  natural  conse- 
quences of  these  perversions.  It  is  scarcely  too  much 
to  say  that  the  average  civilized  man  is  the  victim 
of  chronic  constipation.     If  his  bowels  move  once 

370 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    371 

a  day,  or  even  once  in  two  days,  he  feels  that  his 
condition  is  very  satisfactory;  whereas  Cannon,  in 
his  work  entitled  "The  Mechanical  Factors  of  Di- 
gestion," has  shown  that  practically  all  the  digestible 
food  taken  at  an  ordinary  meal  is  digested  and 
absorbed  within  eight  or  nine  hours  from  the  time 
it  is  eaten,  and  the  unuseable  residue  is  at  the  end 
of  this  period  found  deposited  in  the  colon,  ready 
for  ejection.  Since  the  chief  business  of  the  colon 
is  to  eject  wastes  from  the  body,  why  should  the 
performance  of  its  function  be  so  long  delayed? 
The  colon  contents  are  largely  made  up  of  bacteria 
and  excretory  products,  the  undigestible  elements 
of  the  food  constituting  only  about  one-half  its 
bulk,  while  starch,  fats,  and  protein  are  found  in 
only  very  small  and  negligible  quantities.  It  should 
be  remembered  that  bowel  movement  is  not  simply 
for  the  purpose  of  discharging  the  unuseable  residues 
of  food.  An  equally  essential  reason  for  bowel 
movement  is  the  discharge  of  the  bile  and  other 
highly  poisonous  excretions  which  are  discharged 
into  the  colon  from  the  blood.  No  possible  good,  but 
only  much  harm,  can  come  then  from  the  prolonged 
retention  of  these  body  wastes  and  unuseable  resi- 
dues. There  is  in  fact  no  physiologic  reason  why 
food  residues  should  be  retained  in  the  body  more 
than  twelve  to  eighteen  hours,  or  at  longest  twenty- 
four.  It  is  evident,  then,  that  bowel  movements 
should  occur  at  frequent  intervals,  for  the  purpose 
•f  removing  these  waste   and  poisonous  materiak. 


372  COLON  HYGIENE 

The  natural  intestinal  rhythm,  as  has  been 
previously  explained,  provides  for  an  unloading  of 
wastes  by  a  bowel  movement  after  each  meal  and 
sometimes  an  additional  one  on  rising.  This  requires 
three  or  four  bowel  movements  daily.  Although 
convinced  by  careful  and  extended  observations  in 
dealing  with  many  thousands  of  invalids,  that  the 
bowels  should  be  made  to  move  several  times  a  day, 
the  writer  several  years  ago  set  about  collecting 
from  original  sources  facts  concerning  the  habits 
of  uncivilized  tribes  of  human  beings. 

The  keeper  of  the  London  Zoological  Gardens, 
informed  the  writer  that  the  chimpanzee,  orang,  and 
the  other  large  apes  move  their  bowels  four  times 
daily  with  perfect  regularity.  Professor  Hornaday, 
superintendent  of  the  Bronx  Park  informs  us  that 
the  large  apes  in  the  great  collection  under  his  super- 
vision move  their  bowels  three  times  a  day. 

Extensive  inquiries  made  by  means  of  a  question- 
aire  sent  out  to  physicians  practising  among  primi- 
tive people  in  various  parts  of  the  world,  show  that 
the  custom  among  many  of  those  who  live  in  a 
really  primitive  state,  and  have  been  little  influenced 
by  contact  with  civilization,  is  the  same  as  that  of 
the  higher  apes.  Replies  were  received  from  one 
hundred  and  forty  physicians  who  have  had  abun- 
dant opportunity  to  become  acquainted  with  the 
habits  and  usages  of  the  wild  or  half  civilized  people 
with  whom  they  have  been  closely  associated,  and. 
among  whom  they  have  practiced  for  years.    A  sum- 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    373 

mary  of  these  replies  will  be  found  highly  interest- 
ing, especially  in  the  light  of  the  physiological  facts 
which  have  been  presented  in  the  previous  pages. 
It  is  most  instructive  to  find  wild  and  primitive 
people  in  widely  separated  portions  of  the  globe 
following  identical  usages  to  which  they  have  been 
trained  by  Nature,  the  universal  teacher.  A  com- 
mon instinct  has  led  to  a  practical  uniformity  of 
habits  among  wild  tribes  who  have  not  yet  been 
sophisticated  and  perverted  by  contact  with  civiliza- 
tion. It  is  interesting  also  to  note  the  same  identity 
between  wild  tribes  and  those  most  remarkable 
creatures  of  the  tropical  wilds,  the  anthropoids,  in 
practices  connected  with  eating  and  bowel  action. 
For  much  valuable  and  interesting  information,  a 
small  portion  of  which  is  summarized  in  this 
chapter,  I  am  indebted  to  scores  of  missionary  phy- 
sicians who  have  devoted  their  labors  to  the  noble 
work  of  civilizing  and  Christianizing  the  people  of 
heathen  lands. 

From  the  original  and  authentic  information  the 
fact  appears  that  among  tribes  which  have  been  un- 
influenced by  the  customs  of  civilization,  who  still 
adhere  to  primitive  habits  in  diet,  and  who  live  a 
freef  and  active  life  in  the  wild,  the  bowels  move 
two  or  three  times  daily.  A  single  daily  movement 
is  regarded  by  such  people  as  constipation,  and  gives 
rise  to  alarm.  The  one-movement-a-day  habit  ap- 
pears only  among  those  classes  or  castes  who  live 
a  sedentary  life  and  have  adopted  unnatural  habits 


374  COLON  HYGIENE 

in  diet,  such  as  the  use  of  hot  condiments,  concen- 
trated food,  etc.  The  aristocratic  classes  of  India 
and  China  afford  striking  examples  of  this,  suffering 
much  from  constipation  in  consequence  of  their  idle 
and  luxurious  habits,  and  from  the  use  of  curries 
and  other  unwholesome  condiments,  while  the 
working  classes  whose  diet  and  habits  are  more 
nearly  normal  are  generally  exempt. 

As  regard  the  frequency  of  bowel  movements, 
physicians  located  in  the  following  countries,  re- 
ported the  usual  custom  to  be  two  or  more  daily, 
usually  two,  for  the  very  good  reason  that  two  meals 
only  are  eaten,  the  first  movement  being  on  rising, 
or  after  the  first  meal,  and  the  second  soon  after 
the  second  meal,  or  before  retiring: 

Rhodesia,  Uganda  Protectorate,  Nyassaland,  Ni- 
geria, Harda  (India),  Delhi  (India),  Punjab  (In- 
dia), Kashmir,  Nagpur  (India),  Bawda  (India), 
Persia, — three  or  four  times  in  summer  when  fruits 
are  plentiful.  Aintab  (Turkey),  Harpoot  (Tur- 
key), West  Coast  of  Africa, — tw^o  or  three.  Portu- 
guese Congo, — two  or  three.  Egj^pt, — children 
four  or  five.     Japan,  Arabia, — two  or  three. 

It  is  interesting  to  note  that  the  experience  of 
the  millions  of  primitive  and  half-civilized  people 
who  inhabit  the  above  named  countries  demonstrates 
perfectly  that  an  intake  of  food  should  be  soon  fol- 
lowed by  an  output  of  food  residues  and  wastes. 

In  all  these  countries,   as  among  practically  sM. 


BOWEL  HABil'S  OF  UNCIVILIZED  MAN    375 

primitive  people,  great  attention  is  given  to  the 
bowels.  The  mothers  carefully  train  their  children 
to  move  their  bowels  at  regular  times,  and  much 
pains  is  taken  to  make  the  diet  such  as  to  promote 
intestinal  activity.  The  virtues  of  fruits  and  green 
vegetables  are  fully  appreciated,  and  where  rice 
is  the  principal  food,  as  in  most  of  the  Orient,  large 
use  is  made  of  green  vegetables. 

It  is  especially  of  interest  to  note  the  frequency 
with  which  some  custom  in  relation  to  bowel  hygiene 
is  found  in  vogue  among  primitive  people  who  have 
practiced  it  from  time  immemorial,  while  among 
civilized  people  the  same  practice  has  only  recently 
become  known  as  one  of  the  discoveries  of  modern 
medical  science.  It  is  becoming  more  and  more 
evident  that  our  modern  civilization  in  emerging 
from  barbarism  has  left  behind  much  that  was  not 
only  useful  but  essential  to  a  healthy  physical  life, 
and  we  may  therefore  profit  by  a  careful  study  of 
the  habits  of  primitive  people  and  even  of  those  wild 
animal  species  which  belong  with  man  in  the  class 
of  primates,  and  are  closely  allied  to  the  human 
species  in  structure  and  function. 

Here  are  a  few  extracts  from  the  replies  to  our 
questionaire,  which  will  be  found  most  instructive 
as  well  as  interesting: 

"I  am  of  the  opinion  that  diet  has  a  great  in- 
fluence. The  Labances  eat  plenty  of  figs,  either 
alone  or  mixed  with  juice  of  grapes  or  juice  of  carob 
beans,    brown   bread,    fruits,   vegetables,    olive   oil. 


376  COLON  HYGIENE 

olives,  etc.,  and  drink  plenty  of  spring  water  at 
meal  times." — ^A.  J.  Manasseh,  M.  D.,  Bruana, 
Beyrout,  Syria. 

"Laxative  foods  used  are  the  following:  Cooked 
manioc  leaves,  bananas,  pineapples,  bingondia  (a 
sour-sweet  seedy  fruit),  plantains,  peanuts,  palm 
oil,  pumpkin  seeds  mashed  and  cooked.  Raw  guava 
leaves  are  used  for  diarrhoea,  also  the  clay  mounds 
built  by  white  ants." — Mattie  and  P.  Frederickson, 
Belgian  Congo,  West  Central  Africa, 

It  is  interesting  to  note  that  the  most  primitive 
tribes  of  savages  have  recognized  the  importance  of 
regular  and  frequent  bowel  action  and  provided  for 
the  maintenance  of  this  important  function  by  in- 
cluding in  their  dietary  special  laxative  foods  such 
as  named  above.  This  usage  is  practically  universal 
among  wild  tribes  in  all  parts  of  the  world, 

"In  the  Cape  Colony  the  staple  food  is  stamped 
maize  and  sour  milk;  the  absence  of  the  sour  milk 
leads  to  constipation.  In  the  Northern  Transvaal 
the  staple  food  is  thick  maize  porridge,  sour  milk, 
and,  in  summer,  green  vegetables.  People  go  more 
often  (i.  e.,  say  three  times  a  day)  when  taking 
both  vegetables  and  milk.  When  these  are  scarce, 
they  may  go  only  once," — Neil  Macvicar,  M.  D., 
Lorendall,  South  Africa. 

It  is  especially  interesting  to  note  that  the  Cape 
Colony  natives  have  by  experience  learned  to  ap- 
preciate the  value  of  sour  milk  as  a  laxative  food 
and  corrective  of  intestinal  disorders.     Several  Af- 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    377 

rican  travelers  have  called  attention  to  the  fact  that 
among  the  native  tribes  of  Africa  milk  is  generally 
used  in  the  soured  state.  The  custom  is  to  put  the 
milk  into  a  gourd  at  night  v^^hich  is  reserved  for 
this  particular  purpose.  In  the  morning  the  milk 
is  soured  and  ready  for  use.  At  night  a  new  sup- 
ply of  milk  is  put  into  the  empty  gourd  which  is 
never  washed  and  so  preserves  the  lactic-acid-form- 
ing, ferment  in  an  active  state. 

"The  natives  are,  in  Toro,  almost  entirely  vege- 
tarians, living  on  millet  or  plantains  or  beans. 
They  rarely  get  meat.  In  9642  out-patients  seen 
during  the  last  seven  months  of  1911,  there  were 
174  cases  of  constipation,  one  and  eight-tenths  per 
cent  of  the  whole." — ^J.  Howard  Cook,  M.  D., 
Uganda  Protectorate,  East  Africa. 

In  this  country  the  percentage  of  patients  in 
whom  constipation  is  present  is  just  the  reverse  of 
that  in  Uganda.  Whereas  in  Uganda  there  are 
less  than  two  per  cent  who  are  constipated,  in  civ- 
ilized countries  among  sick  people  there  is  scarcely 
one  in  a  hundred  who  is  not  constipated. 

"The  rather  coarse  diet,  largely  grains  and  vege- 
tables, has  a  favorable  influence  on  the  bowel  move- 
ments. The  stools  are  usually  very  large  and  fairly 
soft." — A.  H.  Norton,  M.  D.,  Haiju,  Korea. 

"The  people  eat  large  quantities  of  rice,  turnips, 
peppers,  roots,  vegetables  and  little  meat.  The 
large  quantity  of  residue  must  act  as  a  stimulus  to. 
peristalsis." — W.  C.  Purviance,  M.  D.,  Chung  Ju, 
Korea. 


378  COLON  HYGIENE 

"Cereals,  as  wheat,  barley,  oats,  millet  seed,  and 
all  kinds  of  vegetables,  are  the  staple  food  here 
(extreme  north  of  Korea)  ;  very  little  fish  and  lass 
meat  is  eaten." — F.  H.  Birdmann,  M.  D.,  Dotson,, 
Korea. 

The  natives  of  Korea  like  those  of  China  and 
Japan  are  generally  known  as  rice  eaters.  It  is  in- 
teresting to  note  that  the  natives  of  Korea  make 
large  use  of  turnips  and  vegetables  and  little  use  of 
meat.  Flesh  foods  are  unquestionably  constipating 
in  their  nature,  not  only  because  they  are  completely 
digestible,  leaving  little  residue  behind,  but  because 
the  putrefaction  to  which  they  give  rise  results  in 
the  formation  of  ammonia  and  other  alkaline  sub- 
stances which  paralyze  the  bowel.  "Meat  bacteria" 
which  swarm  in  all  kinds  of  flesh  foods  are  also  a 
prolific  cause  of  colitis,  which  by  causing  spastic 
contraction  of  the  descending  colon  and  the  pelvic 
colon,  produces  mechanical  obstruction  to  bowel 
movement,  and  also  as  shown  by  Dr.  J.  T.  Case, 
induces  powerful  retro-peristaltic  contractions  by 
which  the  intestinal  contents  are  forced  back  into 
the  right  half  of  the  colon.  The  cecum  and  as- 
cending colon  become  greatly  dilated  as  a  result^ 
and  in  time  the  cecum  becomes  movable  and  pro- 
lapsed. The  stretching  of  the  colon  enlarges  the 
ileocolic  junction  until  the  ileocecal  valve  becomes 
incompetent,  thus  establishing  the  condition  known 
as  intestinal  toxemia  with  its  long  train  of  evil  con- 
sequences. The  vegetarian  habits  of  the  people  of 
Korea  are  without  doubt  of  great  service  to  them 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    379 

in  enabling  them  to  successfully  combat  the  highly 
unsanitary  conditions  under  which  they  live. 

"Bowel  movement  full  and  frequent  among  the 
working  people,  who  eat  large  quantities  of  vege- 
tables ;  more  disturbed  among  the  better  classes,  who 
eat  more  meat." — J.  K.  Cox,  M.  D.,  West  China. 

"My  experience  with  patients  has  been  that  they 
are  not  so  subject  to  constipation  as  persons  in  the 
U.  S.  whom  I  have  treated.  Think  probably  the 
free  use  of  greens  and  other  vegetables  has  some- 
thing to  do  with  the  difference,  as  well  as  not  post- 
poning the  call  of  Nature,  as  is  done  by  civilized 
persons." — Ida  M.  Scott,  M.  D.,  Tak  Hink  Chan, 
South  China. 

"The  vast  majority  of  the  people  live  on  coarse 
grains  and  coarse  vegetables,  which  are  favorable 
to  large  bowel  movements." — Geo.  D.  Lowry, 
M.  D.,  Peking,  China. 

"In  my  own  case,  going  onto  a  purely  local  diet 
«f  rice  and  coarse  vegetables  is  usually  accompanied 
with  looser  motions." — George  Hadden,  M.  D., 
Yung-an  Fookin  Pwo.,   China. 

"Rice  is  the  principal  diet,  but  is  usually  accom- 
panied by  considerable  quantities  of  vegetables, 
largely  what  we  call  greens.  The  Chinese  have  a 
great  variety  of  leaves  and  stocks  that  are  used  for 
greens,  such  as  cabbage,  lettuce,  and  many  other 
kinds  that  we  do  not  see  in  America.  V/itli  this 
diet  and  exercise,  the  healthy  Chinaman  usually  has 
free  bowel  action.     I  think  the  'greens'  is  a  very 


380  COLON  HYGIENE 

suitable  diet  for  this  climate." — Jean  McBurney, 
M.  D.,  Cheung  Chow,  Hong  Kong,  China. 

"Foods  coarse,  and  largely  vegetable,  especially 
among  the  country  people,  which  means  four-fifths 
of  the  population.  Chinese  are  not  meat  eaters  to 
a  great  extent," — F.  F.  Tucker,  M.  D.,  Pangkiach- 
wang,  Shantung,  China. 

"The  natives  eat  much  vegetables,  which  regu- 
late the  bowels." —  Cecil  I.  Davenport,  M.  D., 
Shanghai,  China. 

The  people  of  China  as  well  as  those  of  Korea 
are  evidently  protected  from  the  natural  constipat- 
ing tendency  of  a  rice  diet  by  the  free  use  of  coarse 
vegetables.  The  large  use  of  vegetables  of  all  sorts 
which  is  practiced  in  the  Orient  is  generally  for- 
gotten by  those  who  call  attention  to  the  fact  that 
rice  is  the  staple  foodstuff  in  this  part  of  the  world. 
It  is  true  that  rice  is  the  chief  source  of  nutriment 
but  at  the  same  time  nature  has  taught  these  people 
to  make  ample  provision  for  the  bulk  w^hich  is  es- 
sentially to  stimulate  normal  peristalsis  by  the  use 
of  greens  and  vegetables  of  all  sorts.  Vegetables 
are  used  not  only  during  the  summer  months  but 
at  other  seasons  also.  Turnips  and  several  other 
roots  are  preserved  by  pickling  in  salt  brine  as  cu- 
cumbers are  preserved  in  this  country.  A  very  large 
use  is  also  made  of  bamboo  sprouts,  of  the  leaves 
and  roots  of  certain  lilies  which  are  preserved  by 
drying  and  of  several  varieties  of  seaweed,  from 
some  of  which  a  gelatinous  substance  known  as  Jap- 
anese isinglass  or  agar-agar  is  made  while  others 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    381 

are  used  in  their  native  state  as  Iceland  moss  and 
Irish  moss  are  used  in  this  country. 

"The  natives  note  that  in  eating  pumpkins  and 
prunes  they  have  more  bowel  movements.  An  old 
man  told  me  that  if  a  person,  early  in  the  morning 
before  taking  any  food,  eats  ten  fresh  prunes  from 
the  tree,  he'll  have  bowel  movements  easily." — G. 
Yeram,  M.  D.,  Gumaldjine,  Turkey. 

The  most  primitive  people  have  learned  by  ob- 
servation the  importance  of  bulk,  a  lesson  which  has 
yet  to  be  learned  by  the  great  majority  of  people  in 
civilized  lands.  Knowledge  of  the  laxative  value 
of  fruits,  especially  of  prunes  is,  however,  quite 
widely  diffused.  The  Turkish  peasant  who  told 
our  friend  Dr.  Yeram  that  ten  fresh  prunes  taken 
from  a  tree  would  produce  a  laxative  effect  was 
perhaps  not  aware  however,  that  dried  prunes  may 
be  so  freshened  by  soaking  in  cold  water  for  24 
hours  that  their  laxative  quality  is  to  a  large  ex- 
tent restored.  The  free  use  of  raw  soaked  prunes 
is  a  highly  valuable  food  remedy  for  constipation 
which  has  long  been  in  use  by  many  European  and 
American  physicians. 

"The  principal  food  of  both  city  and  rural  popu- 
lation of  the  region  is  boolghoor  (cracked  wheat, 
which  has  been  cooked,  dried,  and  the  thin  outer 
skin  removed  before  cracking.  It  is  cooked  in  many 
ways.  The  commonest  is  to  boil  it  about  ten  min- 
utes, and  add  a  little  melted  butter  before  serving) , 
and  coarse  bread  of  wheat  or  barley,  varied  by  len- 
tils and  other  legumes,  and  the  fermented  milk  of 


382  COLON  HYGIENE 

the  country  (yougurt  in  Turkish,  leben  in  Arabic, 
or  matzoon  in  Armenian).  The  village  people  eat 
considerable  fruit,  especially  grapes  in  season,  but 
very  little  meat  or  vegetables.  The  city  dwellers 
eat  a  good  deal  of  meat  and  vegetables,  more  fruit, 
and  less  youghurt  than  the  villagers.  They  also 
eat  finer  bread  and  more  spices  and  condiments.  In 
general,  I  may  say  that  constipation  is  relatively 
much  less  common  than  in  America,  and  much  less 
common  among  the  villagers  than  the  city  people; 
in  fact,  very  seldom  seen  in  those  who  eat  boolghoor. 
The  posture  assumed  in  defecation  may  also  have 
something  to  do  with  it.  They  never  sit  on  a  stool, 
but  always  use  the  natural,  squatting  posture.  In 
the  city,  where  they  have  regular  privies,  the  ar- 
rangement is  a  slit  or  opening  in  the  floor,  over 
which  the  person  squats.  The  universal  habit  is  to 
move  the  bowels  three  times  a  day." — F.  D.  Shep- 
ard,  M.  D.,  Aintab,  Turkey. 

The  above  interesting  account  of  the  dietetic  hab- 
its of  the  people  of  Turkey  kindly  sent  us  by  the 
late  Dr.  Shepard  contains  enough  practical  hints 
about  dietetic  methods  of  combating  constipation  to 
enable  almost  any  practical  person  to  formulate  for 
himself  an  efficient  and  laxative  dietary.  It  is  evi- 
dent that  however  much  we  inay  be  in  advance  of 
the  ignorant  Turkish  peasant  in  the  various  forms 
of  culture  which  together  make  up  what  we  call 
civilization,  we  may  study  his  methods  in  diet  with 
great  profit. 

The  matter  of  the  position  in  sitting  at  stool  to 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    385 

•which  Dr.  Shepard  also  called  attention  is  one  of 
no  small  importance.  We  are  learning  more  and 
more  the  importance  of  making  a  careful  note  of 
the  hints  which  nature  gives  us  in  the  instinctive 
leadings  of  animals  and  human  beings  living  in  a 
wild  or  primitive  state  which  have  resulted  in  the 
formation  of  customs  and  habits,  the  essential  re- 
lation of  which  to  our  physical  welfare  has  been 
heretofore  too  much  disregarded. 

In  all  parts  of  Turkej^,  it  is  the  custom  of  the 
people  to  move  the  bowels  three  times  daily  which 
is  the  natural  result  of  the  use  from  early  child- 
hood of  the  several  laxative  foods  above  mentioned. 
Of  this  we  are  assured  by  a  personal  statement  made 
to  the  writer  by  the  late  Dr.  Shepard  who  was 
most  intimately  acquainted  with  the  habits  of  the 
Turkish  people  through  living  and  practicing  among 
them  for  more  than  thirty  years.  That  the  custom 
of  tri-daily  bowel  movement  is  common  to  all 
classes  is  shown  by  an  incident  related  to  the  writer 
by  the  eminent  Sir  Arbuthnot  Lane  of  London, 
England.  The  famous  surgeon  was  one  day  con- 
sulted by  an  official  from  the  Turkish  Embassy  in 
London  who  desired  relief  from  constipation.  When 
asked  for  a  particular  account  of  his  symptoms  he 
admitted  that  his  bowels  moved  once  a  day  but 
declared  that  he  was  greatly  constipated  and  not 
half  a  man,  and  that  when  his  bowels  moved  three 
times  a  day  his  vitality  and  stamina  were  more  than 
doubled. 

"Yoghurt   is   the   form   in   which   milk   is   taken 


384  COLON  HYGIENE 

in  Persia.  We  rarely  see  appendicitis  in  the  natives. 
I  often  wonder  whether  the  yoghurt  may  be  the 
preventive.  The  common  people  live  on  yoghurt, 
cheese,  bread,  and  fruit.  Meat  only  occasionally. 
They  all  consider  milk  (not  yoghurt)  a  laxative, 
and  so  it  seems  to  be  for  the  natives." — ^W.  S. 
Vaunemann,  M.  D.,  Labriz,  Persia. 

It  is  certainly  very  interesting  to  note  that  the 
custom  of  using  sour  milk  should  be  nearly  uni- 
versal among  the  hundreds  of  different  tribes  and 
nations  filling  the  vast  territory  from  the  southern 
tip  of  the  dark  continent  to  Persia.  It  is  also  in- 
teresting to  observe  a  verification  of  the  observa- 
tions made  some  years  ago  by  Dr.  Senn  who  studied 
the  people  of  the  east  coast  of  Africa  and  noted  the 
absence  of  appendicitis,  an  observation  also  con- 
firmed by  Dr.  Lucus-Champonniere  of  France,  who 
found  appendicitis  very  rare  among  the  w^heat-  and 
date-eating  Arabs  of  Algiers,  and  among  the  inmates 
of  prisons  and  insane  asylums  in  France  where  meat 
is  rarely  made  a  part  of  the  bill  of  fare. 

"The  diet  seems  to  favor  looseness,  since  it  con- 
sists largely  of  coarse  bread  from  unbolted  flour; 
also  in  summer  of  large  quantities  of  fruit  in- 
gested."— J.  A.  Funk,  M.  D.,  Hamadan,  Persia. 

The  use  of  superfine  white  flour  appears  to  be 
almost  wholly  confined  to  civilized  nations  and 
there  can  be  no  doubt  that  to  this  practice  is  largely 
chargeable  the  almost  universal  prevalence  of  con- 
stipation in  countries  which  claim  to  be  the  most 
advanced  in  civilization. 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    385 

"It  is  a  common  saying  among  them  that  milk 
acts  as  a  laxative,  especially  if  freshly  milked  and 
unboiled." — P.  W.  Brigstocke,  M.  D.,  Jeiasalem, 
Palestine. 

The  fact  that  boiled  milk  is  constipating  has  long 
been  recognized  in  this  and  other  civilized  countries. 
It  appears  that  the  same  fact  is  known  to  the  un- 
educated natives  of  Syria.  It  is  only  recently  that 
science  has  offered  the  explanation  which  has  been 
supplied  by  the  bacteriological  laboratory  that  boiled 
milk  undergoes  putrefaction  in  the  intestine  because 
of  the  destruction  of  the  acid-forming  bacteria  which 
abound  in  raw  milk  which  has  been  exposed  to  the 
air,  and  stimulate  bowel  action  and  prevent  putre- 
faction. 

"The  diet  is  largely  a  vegetable  and  cereal  one, 
meat  being  eaten  only  occasionally." — ^A.  F.  Grant 
M.  D.,  Assiut,  Egypt. 

It  is  instructive  to  note  that  the  Egyptians  are 
still  as  in  ancient  times  practically  non-flesh  eaters. 
The  experience  of  two  or  three  thousand  years  has 
not  convinced  these  simple  tillers  of  the  soil  that 
the  natural  products  of  the  earth  are  not  capable 
of  affording  ample  and  sufficient  nourishment.  The 
fertile  valley  of  the  Nile  in  centuries  far  remote 
from  the  present  supported  a  population  perhaps 
more  dense  than  has  been  maintained  in  any  other 
part  of  the  world.  It  may  be  that  some  future  time 
will  again  see  this  highly  favored  region  teeming 
with  human  life  and  enterprise,  supported  as  of  old 
by  the  products  of  its  marvelously  fertile  soil. 


386  COLON  HYGIENE 

"The  coarse  simple  diet — millet  or  corn  porridge 
or  bread,  cabbage,  soup,  etc. — of  the  country  seems 
to  favor  regularity  of  the  bowels." — Mrs.  Estella 
A.  Perkins,  M.  D.,  Pao  Ting,  China. 

"The  almost  exclusive  vegetable  diet — rice,  cab- 
bage, etc., — seems  on  the  whole  to  be  favorable,  and 
constipation  is  not  so  common  among  the  sedentary 
classes  as  might  be  expected." — B.  S.  Browne, 
M.  D.,  Ningpo,  China. 

"Constipation  is  not  common,  but  the  inhabitants 
of  Manchuria  are  mostly  vegetarians,  i.  e.,  eat  little 
butcher  meat  except  on  festive  occasions." — Drs. 
Christie  and  Muir,  Mukden. 

"People  suffering  from  diarrhoea  frequently  take 
rice  and  'dahi'  (curds,  sour  milk),  to  check  it. 
Ordinary  milk  they  generally  consider  constipat- 
ing."—N.  C.  Henderson,  M.  D.,  India. 

A  specimen  of  dahi  sent  us  by  a  friend  from 
Darjeling  was  found  to  be  practically  identical  with 
the  yoghourth  of  Bulgaria,  the  matzoon  of  Armenia 
and  the  leben  of  Egypt.  The  so-called  Bacillus 
Bulgaricus  is  apparently  the  active  acid  producer 
in  all  these  fermented  milks.  The  strain  obtained 
from  dahi  appeared  to  be  particularly  active,  grow- 
ing with  much  vigor  and  producing  lactic  acid  very 
freely. 

"People  eat  wheat,  Indian  corn,  and  millet  seed 
breads.  The  first  named  is  supposed  to  be  consti- 
pating, and  the  last  two  laxative." — W.  L.  Pennell, 
M.  D.,  Bannu,  India. 

"The   coarse   wheat   and   barley    flour   used   for 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    387 

their  bread  is,  without  doubt,   favorable  to  regu- 
larity."— Edna  B.  Kuslar,  M.  D.,  Phalera,  India. 

It  is  probably  not  known  to  most  civilized  peo- 
ple that  wheat  as  well  as  rice  is  very  largely  used 
in  India.  England  annually  obtains  enormous 
quantities  of  wheat  from  her  Indian  provinces  the 
price  of  which  is  such  that  the  Hindu  peasant  finds 
it  necessary  to  make  rice  his  staple,  although  con- 
siderable quantities  of  wheat  bread  are  used  by  the 
wealthier  classes.  It  is  interesting  to  note,  hovv^ever, 
that  the  wheat  thus  used  by  the  natives  is  chiefly 
employed  in  the  state  of  coarse  meal,  rather  than 
the  fine  bolted  flour  from  which  two  most  impor- 
tant elements,  cellulose  and  vitamines,  have  been 
removed  by  the  milling  process. 

"Usual  diet  of  rice  with  green  vegetables,  lentils 
or  occasionally  meat,  favors  regular  motions.  Boiled 
radishes  favor  diarrhoea,  and  fish  favors  constipa- 
tion."— Dr.  Minnie  Gomery,  Idlamabad,  Kashmir. 

"Diet,  rice  and  vegetables,  rarely  meat.  Rice  is 
eaten  in  great  excess.  People  pass  large  stools,  as 
a  lot  of  rice  is  ejected.  Presumably  nitrogen  and 
salts  are  used  up  and  starch  excreted." — H.  E. 
Rawlence,  M.  D.,  Srueagai,  Kashmir,  India. 

Even  remote  Kashmir,  which  has  been  so  little 
in  touch  with  modern  civilization,  appears  to  be 
really  up  to  date  in  matters  dietetic.  Meat  is  only 
used  occasionally,  whereas  green  vegetables  and 
lentils  combined  with  rice  constitute  the  regular 
dietary. 

The  passing  of  quantities  of  undigested  rice  is 


388  COLON  HYGIENE 

doubtless  due  to  the  fact  that  the  rice  is  imperfectly 
cooked,  a  custom  very  common  in  rice-eating  coun- 
tries, and  perhaps  a  wholesome  one.  The  Scotch 
highlander  eats  his  oatmeal  less  than  half  cooked 
and  is  wonderfully  sturdy.  Some  undigested  starch 
in  the  feces  prevents  putrefaction. 

The  diet  being  chiefly  vegetarian  (among  the 
Hindus  it  is  so  entirely),  the  large  amount  of  vege- 
tables taken  seems  to  act  as  the  necessary  stimulus 
to  the  bowel." — Robert  Madison,  M.  D.,  Rajshalu, 
India. 

"Diet  of  the  people  mostly  fruit  and  vegetable. 
Have  found  that  when  fruit  and  salad  oil  could  be 
added,  tongues  are  clean,  moist  and  red.  Where 
the  white  bread  is  taken  in  imitation  of  the  for- 
eigner, troubles  begin  similar  to  those  at  home.  The 
national  custom  is  to  eat  but  two  meals  a  day." — 
Belle  J.  Allen,  M.  D.,  Baroda  Camp,  India. 

The  observation  made  by  Dr.  Allen,  that  the 
natives  of  India  begin  to  suffer  from  constipation 
when  they  adopt  the  use  of  white  bread,  though 
previously  free  from  this  curse  of  civilization,  is 
highly  instructive.  It  is  interesting  to  note  that 
the  U.  S.  Agricultural  Department  is  making  a 
strong  effort  to  bring  to  the  notice  of  the  American 
the  importance  of  using  the  whole  grain  instead  of 
discarding  the  outer  portion  or  bran  which  is  now 
known  to  contain  by  far  the  largest  share  of  the 
lime  essential  for  perfect  nutrition  as  well  as  the 
highly  essential  vitamines.  It  is  also  interesting  to 
note  that  though  the  native  of  India  as  well  as  of 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    389 

most  other  countries  of  the  globe  eat  but  two  meals 
a  day,  the  prevailing  bowel  habit  among  these  peo- 
ple is  two  or  three  movements  daily.  More  fre- 
quent meals  should  give  rise  to  more  frequent  move- 
ments and  would  doubtless  produce  this  efEect  in 
this  and  most  civilized  countries  were  it  not  for  the 
highly  concentrated  and  highly  constipating  char- 
acter of  the  diet. 

"Motions  are  large,  bulky  and  not  formed,  but 
pultaceous.  People  of  these  parts  eat  largely  of 
ground  wheat  and  vegetables,  not  much  meat.  Hin- 
dus seldom  eat  flesh." — A.  H.  Browne,  M.  D.,  Am- 
ristsar,  India. 

"Meat  tends  to  constipate;  vegetables  and  milk 
tend  to  loosen." — M.  M.  Brown,  M.  D.,  Sargodha, 
Punjab,  India. 

Dr.  Brown  as  well  as  other  close  observers  of  the 
relation  of  diet  to  health  among  people  of  simple 
habits  notes  the  effects  of  a  meat  diet  in  producing 
constipation.  The  reason  for  this  as  indicated  else- 
where is  that  a  meat  diet  produces  colitis  and  in- 
testinal putrefaction. 

"People  coming  from  the  interior  are  much  more 
regular  than  those  living  in  Smyrna,  where  more 
meat  is  eaten  than  in  the  interior.  After  some  time 
in  Smyrna,  such  people  tend  to  become  less  regular." 
— D.  McKenzie  Newton,  M.  D.,  Smyrna. 

"The  use  of  peanuts  in  all  forms,  and  the  eating 
of  cooked  green  leaves  of  several  kinds,  used  daily 
keeps  their  bowels  in  good  shape." — A.  Sims  Roma, 
M.  D.,  Ferrovia,  Italy. 


390  COLON  HYGIENE 

"On.  the  ordinary  native  diet  there  is  scarcely 
ever  any  constipation.  On  other  diet,  occasionally." 
— E.  MacKenzie,  M.  D.,  Hog  Harbor,  Santo,  New 
Hebrides. 

Rare  Occurrence  of  Cancer  and  Appendi- 
citis Among  Primitive  Tribes 

It  is  the  universal  testimony  that  cancer  and  ap- 
pendicitis are  extremely  rare.  Doctor  Shepard,  of 
Aintab,  Turkey,  who  has  had  an  enormous  practice 
among  the  Turks  for  more  than  a  quarter  century, 
and  is  perhaps  recognized  as  the  leading  abdominal 
surgeon  of  the  Orient,  writes: 

"There  is  relatively  very  little  appendicitis  here. 
I  do  from  500  to  600  important  surgical  operations 
a  year,  but  only  six  to  eight  appendectomies.  Can- 
cer of  the  intestinal  tract  is  quite  rare  (as  are  all 
forms  of  cancer) ,  although  ulcer  of  the  stomach  is 
common." 

Dr  .  W.  W.  Peter,  of  Shanghai,  says,  "I  never 
heard  of  appendicitis  in  a  Chinaman." 

The  fact  that  cancer  is  a  disease  peculiar  to  ad- 
vanced civilization  is  clearly  shown  by  the  replies 
received  from  one  hundred  and  twelve  physicians 
located  in  the  following  countries:  Mexico,  Pales- 
tine, Arabia,  Turkey,  Egypt,  South  Africa,  East 
Africa,  Central  Africa,  Nigeria,  Japan,  Syria,  Ko- 
rea, Persia,  Siam,  India,  Asia  Minor,  New  Hebri- 
des. Forty-three  of  the  one  hundred  and  twelve 
reported  that  they  had  never  seen  cancer  of  the 
bowels.      Nine  physicians   from   different  parts  of 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    391 

Africa,  the  west  coast,  Tunis,  Nigeria,  Rhodesia, 
Uganda,  East  Africa,  British  Central  Africa,  the 
Portuguese  Congo  and  Belgian  Congo  all  report 
having  never  seen  a  case  of  cancer  of  the  bowels 
among  the  natives. 

Primitive  Remedies  for  Constipation 

The  following  extracts  from  replies  to  our  ques- 
tionaire  illustrate  the  habits  of  people  in  relation 
to  bowel  movements  and  the  simple  but  often  highly 
sensible  methods  employed  by  them  for  relief: 

"The  chief  duty  of  the  Indleburds,  or  priestly 
caste,  is  the  care  of  such  matters  (the  movement 
of  the  bowels).  A  fine  is  levied  in  case  of  neglect." 
—P.  N.  Darling,  M.  D.,  India. 

The  observation  of  Dr.  Darling  that  one  of  the 
duties  of  the  priest  in  India  is  to  educate  the  people 
in  reference  to  the  proper  care  of  the  bowels  is 
highly  suggestive.  In  this  country,  the  subject  of 
bowel  hygiene  has  been  so  universally  neglected  that 
even  parents  are  quite  ignorant  concerning  the  bowel 
habits  of  their  children  and  often  allow  them  to 
drift  into  diseased  conditions,  the  evil  effects  of 
which  are  felt  throughout  their  entire  lifetime. 
Physical,  mental  and  moral  evils  resulting  from 
constipation  are  so  great  that  it  is  not  an  exaggera- 
tion to  say  that  teachers  as  well  as  preachers  could 
not  make  a  better  use  of  a  portion  of  their  time 
and  talents  than  by  the  education  and  training  of 
the  children  in  the  proper  care  of  the  colon. 

"The  natives  give  prompt  attention  to  the  bowels. 


392  COLON  HYGIENE 

I  have  again  and  again  had  it  given  me  as  a  reasott 
for  not  living  in  Aden,  that  people  had  there  to  go 
to  the  closet  in  order  to  evacuate  their  bowels, 
rather  than  relieve  themselves  any  place,  as  this  was 
only  permitted  for  children." — ^John  C.  Young, 
M.  D.,  Sheikh  Othman,  Aden. 

The  above  observation  by  Dr.  Young  aflFords 
powerful  testimony  to  the  importance  attached  by 
the  Arabs  to  the  prompt  response  to  the  call  of 
nature  for  evacuation  of  the  bowels. 

Dr.  Davidson  of  Travancore,  India,  says:  "Ap- 
pendicitis very  rare  here.  Only  about  six  cases  out 
of  at  least  1,000  major  operations." 

Dr.  Davidson's  experience  in  meeting  only  six 
cases  of  appendicitis  among  a  thousand  major  op- 
erations is  striking  evidence  of  the  rarity  with  which 
appendicitis  occurs  among  non-flesh  eating  people. 
This  observation  agrees  with  that  of  Dr.  Senn  who 
noted  the  absence  of  appendicitis  among  the  vege- 
table-eating natives  of  the  east  coast  of  Africa.  An 
examination  of  the  annual  report  of  the  Mayo 
Clinic  shows  19  per  cent  of  all  cases  examined  to 
be  suffering  from  appendicitis,  and  at  operation  the 
appendix  was  found  diseased  and  requiring  re- 
moval in  21  per  cent  of  all  cases  operated,  whereas, 
Dr.  Davidson  found  in  India  only  six  tenths  of 
one  per  cent,  a  frequency  thirtj^-five  times  less. 

"No  instruments  used;  people  generally  boil  mo- 
lasses (not  maple,  but  grape  juice)  and  common 
salt  together  to  the  consistency  of  wax,  and  make 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    393 

suppositories  to  apply  per  rectum." — S.  C.  Kaval- 
gian,  M.  D.,  Ada  Pazar,  Asia  Minor,  Turkey. 

"In  cases  of  constipation  or  obstruction,  very 
forcible  measures  are  employed,  such  as  massage, 
kneading  the  abdominal  wall  and  exerting  pressure 
upon  the  abdomen,  and  even  kicking." — E.  Mar- 
garet Phillips,  M.  D.,  Ping  Yin,  China. 

"Brovi^n  sugar  is  the  laxative  usually  relied 
upon." — Walter  W.  Williams,  M.  D.,  Yung-an 
Fookin  Pwo.,  China. 

The  above  observations  in  China  and  Turkey 
show  the  sagacity  of  primitive  people  in  discovering 
simple  food  remedies  for  constipation.  When  taken 
in  large  quantities,  sugar  produces  laxative  effects, 
not  only  because  of  its  specific  stimulating  effect 
upon  the  intestine  but  because  of  the  stimulating 
effect  of  the  lactic  acid  produced  by  the  fermenta- 
tion of  the  sugar  in  the  colon. 

"For  relief  of  constipation  a  sort  of  large  rolling 
pin  is  freely  rolled  up  and  down  the  abdomen  while 
the  patient  is  lying  supine," — H.  G.  Barrie,  M.  D., 
Kuling,  China. 

The  use  of  the  rolling  pin  as  a  means  of  reliev- 
ing constipation  is  an  original  Chinese  invention, 
although  a  cannon  ball  as  well  as  various  kinds  of 
apparatus  have  been  long  in  use  in  this  country  as 
a  means  of  mechanically  stimulating  the  bowels  to 
activity. 

"They  use  a  smooth  stalk  of  millet  to  stimulate 
the  lower  bowel." — Elizabeth  Beatty,  M.  D., 
Kvv^angning,  Manchuria,  China. 


394  COLON  HYGIENE 

Mechanical  stimulation  of  the  rectum  has  long 
been  known  to  be  a  powerful  means  of  exciting 
peristalsis,  but  the  method  is  not  to  be  recom- 
mended because  of  the  danger  of  producing  in- 
flammation and  infection  of  the  rectum,  the  result 
of  which  might  lead  to  hemorrhoids,  fissure  or  ab- 
scess, inducing  fistula. 

"A  very  crude  method  for  giving  an  enema  is 
to  take  a  small  slender  piece  of  bamboo  for  a  nozzle 
and  a  bag  made  of  pig  gut,  and  use  it  as  a  syringe." 
—William  M.  Berss,  M.  D.,  Chenchow,  South 
Hunan,  China. 

"They  have  no  instruments,  but  often  use  honey 
suppositories." — ^W.  H.  Park,  M.  D.,  Soochow, 
China. 

"They  have  a  funnel-shaped  enema  w^hich  is  be- 
ing displaced  by  European  bulb  syringes." — ^J.  Da- 
vidson Frazier,  M.  D.,  Resht,  Persia. 

"The  people  have  few  or  no  remedies,  save  the 
drinking  of  a  large  quantity  of  hot  water,  which 
they  often  do  when  conscious  of  the  need,  and  with 
quite  good  effect." — H.  W.  Schwartz,  M.  D., 
Yokohama,  Japan. 

"Massage  is  employed ;  drugs  very  rarely." — 
Walter  Virden,  M.  D.,  Rhodesia,  South  Africa. 

"Enemata  given  in  the  knee-elbow  position  with 
a  funnel  made  of  a  leaf,  and  a  pipe  made  of  a 
gourd  or  vegetable  stump." — J.  Howard  Cook, 
M.  D.,  Fort  Portal,  Uganda  Protectorate,  East 
Africa. 

It  is  interesting  to  note  that  even  the  mem- 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    393 

bers  of  savage  tribes  are  acquainted  with  the  value 
of  the  enema  and  have  been  able  to  improvise 
means  for  the  getting  of  water  into  the  bowels^ 
Some  of  the  means  employed  are  like  the  above 
very  highly  ingenious.  It  is  also  interesting  to 
learn  from  the  observations  of  Dr.  Cook  of  the 
employment  of  the  knee-elbow  position  by  the  na- 
tives of  Uganda.  The  credit  for  the  invention  of 
the  knee-elbow  position  has  been  given  to  an  Amer- 
ican physician.  It  seems,  however,  that  in  this 
particular  civilized  people  are  as  in  many  other 
ways  in  matters  pertaining  to  physical  welfare, 
easily  outdone  by  the  natives  of  many  primitive 
tribes. 

"Roots  are  sometimes  cooked  in  water  and  given 
as  an  enema  by  means  of  an  ox  horn  with  perforated 
end — large  quantity  poured  in.  In  the  Northern 
Transvaal  purgatives  are  not  required.  Enema  ap- 
pliances not  known." — Neil  Macvicar,  M.  D., 
Lorendall,  South  Africa. 

"The  natives  regularly  use  enemata,  introduced 
with  gourds." — D.  Robertson,  M.  D.,  Itu,  South 
Nigeria. 

"They  have  medicines  for  use  as  purgatives,  and 
also  use  enemas,  which  are  administered  by  means 
of  a  sort  of  gourd  with  long  neck.  The  gourd  is 
filled,  and  the  water  flows  in  by  gravitation.  The 
patient  lies  prone." — E.  C.  Sirley,  M.  D.,  W.  Coast 
of  Africa. 

"The  use  of  common  soap  passed  up  into  the  anus 
or  some  similar  substance  is  often  used  by  the  na- 


396  COLON  HYGIENE 

tives  of  this  country  to  overcome  constipation." — 
W.  O.  Ballantine,  M.  D.,  Rahuri,  Western  India. 

"Soap  suppositories  is  a  common  native  remedy; 
enemas  are  never  used;  they  consider  it  shameful. 
Massage  of  the  abdominal  wall  is  practiced,  too." — 
R.  T.  H.  Cox,  M.  D.,  Persawan,  N.  India. 

The  Hindu  mother  knows  the  value  of  the  sup- 
pository as  a  remedy  for  infants  as  well  as  does  the 
American  mother.  Experience  is  a  wonderful 
teacher  and  in  this  school  the  most  ignorant  savage 
mother  has  just  as  good  an  opportunity  to  learn 
and  make  advancement  as  the  mother  of  the  most 
highly  civilized  land. 

"A  smack  in  the  stomach  with  a  colo  spade  is 
often  used,  and  is  invariably  productive  of  a  profuse 
and  continued  motion.  Some  of  the  hill  tribes  carry 
under  the  left  arm  pit  finely  engraved  brass  tongs 
for  the  purpose  of  extracting  in  their  entirety  the 
masses  of  fecal  matter.  These  are  shaped  by  the 
women  of  the  tribe,  and  are  used  in  their  war 
catapults  in  tribal  warfare." — P.  N,  Darling,  M. 
D.,  India. 

This  drastic  method  of  stimulating  bowel  action 
may  sometimes  produce  injury,  but  could  not  pos- 
sibly be  more  productive  of  mischief  than  is  the 
common,  almost  universal,  use  in  all  civilized  coun- 
tries of  laxative  mineral  waters  and  drastic  cathar- 
tic remedies  of  all  sorts. 

"The  population  generally  deal  largely  in  drastic 
purgatives.  A  man  will  take  a  month's  leave  from 
work  for  nothing  more  than  a  course  of  purgation. 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    397 

often  very  severe." — F.  V.  Thomas,  M.  D,,  Palwal, 
near  Delphi,  India. 

This  method  of  dealing  with  constipation  could 
scarcely  be  more  injurious  than  the  continued  use 
of  stomach  and  colon  irritating  drugs.  As  Von 
Noorden  well  says,  "nothing  is  so  bad  as  the 
chronic  use  of  laxative  drugs." 

"The  native  position,  squatting  at  stool,  with 
front  of  thigh  against  the  abdomen,  encourages 
evacuations." — ^W.  J.  Maule,  M.  D.,  Miraj,  India. 

The  squatting  position  in  moving  the  bowels  ap- 
pears to  be  universal  among  all  people  with  the 
exception  of  those  who  call  themselves  civilized. 
It  is  singular  indeed  that  in  relation  to  this  most 
important  function  of  the  body  the  wildest  and  most 
unsophisticated  natives  are  really  in  advance  of  the 
most  highly  civilized  people.  The  value  of  the 
squatting  position  as  a  means  of  relieving  the  bowels 
has  been  recognized  for  years  but  the  knowledge 
has  had  little  influence  upon  the  habits  of  the  peo- 
ple in  this  particular.  It  is  pointed  out  elsewhere 
in  this  work  how  the  objectionable  features  of  the 
ordinary  closet  seat  may  be  overcome  by  elevating 
the  feet  upon  a  stool  eight  or  ten  inches  high  placed 
in  front  of  the  closet  seat. 

"The  position  in  which  the  native  helps  his  ex- 
pulsion of  feces  from  colon  and  rectum  is  this:  he 
sits  on  his  haunches  and  presses  the  left  side  of  the 
lower  abdomen  with  the  hand  or  a  bunch  of  cloth." 
— T.  Davidson,  M.  D.,  South  Travancore,  South 
India. 


398  COLON  HYGIENE 

The  practice  above  referred  to  by  Dr.  Davidson 
is  interesting  evidence  of  the  East  Indian's  capacity 
for  intelhgent  observation.  The  descending  colon 
and  pelvic  colon  are  located  in  the  lower  left  side 
of  the  abdomen  and  pressure  just  at  this  'point  may 
be  of  the  greatest  value  in  aiding  evacuation  of  the 
bowels.  The  writer  has  for  many  years  recom- 
mended patients  to  assist  themselves  when  neces- 
sary by  pressing  firmly  with  the  closed  fist  or  with 
both  fists  upon  the  left  side  of  the  lower  abdomen. 
Deep  pressure  made  at  this  point  will  often  arouse 
the  lower  bowel  to  immediate  action,  causing  in- 
stantaneous expulsion  of  gas  and  in  many  cases 
within  a  few  seconds  a  large  evacuation  of  retained 
fecal  matters.  The  use  of  a  bunch  of  cloth  for  the 
purpose  of  increasing  the  pressure  is  an  original  in- 
vention of  the  East  Indian  and  is  highly  suggestive. 
A  patient  recently  reported  to  the  writer  the  dis- 
covery that  a  newspaper  folded  into  a  round  mass 
serves  an  excellent  purpose  for  making  compression 
over  the  pelvic  colon. 

"The  use  of  a  piece  of  oiled  soap  is  common, 
which  may  have  been  learned  from  the  English; 
an  oiled  rag  is  used,  too." — A  Missionary  Physi- 
cian of  India. 

For  more  than  thirty  years  the  writer  has  made 
occasional  use  of  an  oiled  ball  of  cotton  or  of  a 
cheese  cloth  pledget  saturated  with  oil  and  placed 
in  the  rectum  at  night  as  a  means  of  combating  cer- 
tain forms  of  constipation.  The  results  have  been 
very  excellent.     Saturation  of  the  pledget  with  a 


BOWEL  HABITS  OF  UNCIVILIZED  MAN    399 

culture  of  the  Bacillus  Bulgaricus  is  still  more  ef- 
fective in  some  cases. 

"The  chief  practice  is  the  habit  of  squatting  at 
stool.  Have  had  patients  leave  the  Hospital  be- 
cause they  could  not  have  a  normal  movement  w^ith- 
out  their  own  kind  of  commode.  Complaints  ceased 
with  a  native  place  provided." — Belle  J.  Allen, 
M.  D.,  Baroda  Camp,  P.  O.,  India. 

An  opening  in  the  floor  over  which  the  user 
squats  is  the  provision  made  for  bowel  evacuation 
in  many  parts  of  France,  as  well  as  in  Oriental 
countries.  Even  in  Paris,  as  recently  as  twenty 
years  ago,  the  writer  found  this  arrangement  in  use 
in  the  small  hotels  of  the  suburbs  of  the  city.  It 
is  interesting  to  note  that  Dr.  Allen's  patients  were 
willing  to  forego  the  advantages  of  hospital  care 
rather  than  suffer  the  serious  consequences  of  dis- 
turbed bowel  action  from  interference  with  the 
normal  mode  of  defecation. 

A  missionary  physician  writing  us  from  South 
Africa  related  the  following  incident  as  an  illustra- 
tion of  the  care  which  the  natives  take  to  secure  free 
movement  of  the  bowels.  Said  the  doctor,  "A  na- 
tive called  on  me  yesterday  morning  and  asked  for 
medicine  to  relieve  a  dreadful  constipation.  I  said 
to  him,  "When  did  your  bowels  move  last?"  He 
replied,  "This  morning,  Doctor."  "But  I  under- 
stood you  to  say  you  were  constipated."  "Yes," 
replied  the  native,  "I  am  horribly  constipated.  My 
bowels  only  move  once  a  day." 

Since  the  publication  of  the  first  edition  of  this 


400  COLON  HYGIENE 

work  the  writer  has  learned  from  Dr.  Wilfred 
Grenfell,  of  Labrador,  that  it  is  the  custom  in  that 
country  to  feed  reindeer  moss  to  the  dogs  that  are 
used  almost  exclusivelj'^  for  transportation.  After 
mixing  with  oil  the  moss  is  eaten  by  the  dogs  with 
great  avidit}^  and  they  appear  to  thrive  upon  it.  It 
is  strange,  indeed,  that  civilized  man  should  be 
about  the  only  creature  among  the  members  of  the 
animal  kingdom  who  neglects  to  supply  his  alimen- 
tary canal  with  the  material  necessarj^  to  supply  the 
intestine  with  the  normal  stimulus  to  action.  In 
civilization,  domestic  animals  fare  better  than  hu- 
man beings  in  this  regard.  When  the  horse,  ox,  or 
cow  loses  appetite  and  becomes  constipated,  bran 
mash  is  the  farmer's  ready  and  efficient  remedy. 
But  strange  to  say  the  farmer  never  thinks  of  giving 
himself  the  benefit  of  this  simple  and  natural  rem- 
edy, but  instead  dopes  himself  with  purgative  pills 
or  mineral  waters  which  ruin  his  digestion,  spoil 
his  kidneys,  increase  constipation,  and  ultimately  in- 
duce colitis,  one  of  the  most  common  and  most  for- 
midable of  all  the  evil  effects  produced  by  chronic 
constipation. 

THE  COLON  CODE 

1.  Move  the  bowels  at  least  three  times  a  day. 
(See  pages  211,  212,  219.) 

2.  Answer  the  "call,"  even  the  slightest,  at  once. 
Delay  of  five  or  ten  minutes  mav  be  disastrous. 
(See  pages  42-50,  122-124,  208.) 

3.  Give  the  bowels  an  opportunity  for  evacua- 


THE  COLON  CODE  401 

tion  on  rising,  at  bedtime,   and  after  each  meal, 
even  if  there  is  no  call.     (See  pages  40-50.) 

4.  Allow  sufficient  time  for  complete  and  thor- 
ough evacuation  of  the  colon.     (See  pages  125-128.) 

5.  If  the  "call"  returns  after  a  movement,  make 
a  second  or  even  a  third  visit  to  the  toilet.  (See 
page  214.) 

6.  Place  a  stool  in  front  of  the  closet  seat  to 
raise  the  feet.     (See  page  128.) 

7.  Eat  laxative  food  at  every  meal.  A  single 
omission  may  upset  the  bowel  system  for  several 
days.     (See  pages  220-234.) 

8.  If  necessary  to  secure  three  full  evacuations 
daily,  take  a  tablespoonful  of  bran,  or  one-third  of 
an  ounce  of  agar-agar,  and  half  an  ounce  to  an 
ounce  of  white  Russian  paraffin  oil  at  each  meal. 
(See  pages  231-239.) 

9.  Eat  regularly  and  avoid  concentrated  foods. 

10.  Change  the  intestinal  flora  by  the  fruit  reg- 
gimen  or  the  milk  regimen  (186-188).  The  consti- 
pation will  not  be  permanently  cured  so  long  as  the 
stools  are  putrescent  or  very  foul  smelling. 

11.  Drink  two  or  three  quarts  of  water  daily, 
one  or  two  glasses  of  cold  water  at  bedtime  and  the 
same  on  rising.     (See  pages  111,  112,  118.) 

12.  Take  deep  breathing  and  abdominal  exer- 
cises daily.     (See  pages  69,  84,  114-116,  272-298.) 

13.  Wear  loose  clothing  and  if  the  abdomen  sags 
wear  a  spring  supporter  constantly  when  on  the 
feet.     (See  pages  84,  203,  298.) 


402  COLON  HYGIENE 

14.  If  necessaty,  use  an  enema  after  breakfast — 
three  pints  of  water  at  80°  to  70°  F.  A  smaller 
enema  of  cool  water  (one-half  to  one  pint)  may  be 
used  after  each  meal  or  after  dinner  and  at  bed- 
time to  establish  the  three-a-day  rhythm.  (See  page 
312.) 

15.  A  small  enema  (half  pint  of  tepid  or  cool 
water  at  bedtime  often  secures  a  good  morning 
movement.  An  enema  of  a  few  ounces  of  paraffin 
oil  (four  to  six)  may  be  used  to  combat  dryness  of 
the  stool.     (See  page  312.) 

16.  In  many  cases  of  colitis,  with  spastic  contrac- 
tion of  the  descending  or  pelvic  colon,  a  complete 
movement  rarely  occurs.  The  feces  are  slowly 
pushed  through  the  constricted  bowel.  In  such 
cases  what  may  be  termed  supplementary  bowel 
movements  are  necessary.  A  few  minutes  after  the 
movement,  or  it  may  be  an  hour  after,  a  slight 
"call"  may  be  experienced.  This  should  be  re- 
sponded to  at  once,  and  even  if  the  call  is  repeated. 
When  the  bowels  do  not  move  satisfactorily,  it  is 
well  to  wait  for  several  minutes,  meantime  occupy- 
ing the  mind  with  reading  the  morning  paper,  per- 
haps. This  affords  time  for  a  new  instalment  of 
waste  material  to  be  pushed  down  from  the  upper 
part  of  the  colon. 

17.  A  very  hot  sitz  bath  for  two  to  five  minutes, 
or  a  hot  fomentation,  taken  before  breakfast,  is  an 
excellent  means  of  relaxing  the  contracted  colon  in 
cases  of  colitis,  and  so  preparing  the  bowel  for  a 

pod  after-breakfast  evacuation. 


COLON  CODE  ,  403 

18.  Fruit  on  rising,  and  on  going  to  bed,  may  be 
taken  when  necessary  as  an  aid  to  other  measures. 
One  or  two  oranges,  an  apple,  a  couple  of  plums,  or 
a  dish  of  berries  eaten  without  cream  (malt  sugar 
may  be  added),  or  a  bunch  of  flresh  grapes  are  suit- 
able for  this  purpose.  The  fruits  named  do  not  tax 
the  digestive  organs  because  they  contain  no  fat, 
very  little  protein,  and  no  raw  starch,  the  starch 
having  been  digested  by  the  process  of  ripening. 
They  are  all  rich  in  vitamines  and  highly  refresh- 
ing. When  taken  into  the  stomach  they  induce  a 
lively  peristalsis  which  is  continued  down  the  in- 
testine and  helps  to  advance  the  fecal  mass  toward 
the  point  of  exit.  The  fruit  taken  on  rising  helps 
to  secure  a  full  bowel  movement  after  breakfast. 
The  fruit  at  bedtime  prepares  the  way  for  a  bowel 
evacuation  on  rising. 

THE  CARMINE  TEST  FOR  INTESTINAL 
MOTILITY 

The  length  of  time  required  for  the  passage  of 
material  through  the  alimentary  canal  may  be 
readily  ascertained  by  the  administration  of  some 
substance  which  will  give  to  the  intestinal  contents 
a  decided  color  which  can  be  easily  recognized. 
Animal  charcoal,  carmine  and  even  highly  colored 
fruit,  such  as  the  huckleberry,  may  be  used  for  this 
purpose.  It  is  necessary,  of  course,  that  while  tak- 
ing the  test  care  should  be  taken  to  avoid  taking 
foods  of  such  a  color  as  might  lead  to  confusion 


404  COLON  HYGIENE 

with  the  color  of  the  test  substance.  In  applying 
the  test,  two  capsules  containing  five  grains  each  of 
carmine  are  usually  given  at  breakfast,  say  at  8  A.  M. 
Each  stool  is  afterwards  examined  and  the  time 
noted  when  the  red  color  of  the  carmine  appears. 
The  examination  of  the  stools  continues  until  the 
color  disappears.    This  time  is  also  noted. 

From  a  large  number  of  observations,  several 
hundred,  it  has  been  determined  that  in  a  normal 
person  the  color  should  make  its  appearance  within 
twelve  hours  from  the  time  it  has  been  taken  and 
should  disappear  within  twenty-five  hours.  In  a 
considerable  number  of  persons  the  color  appears 
in  less  than  twelve  hours  and  disappears  in  eighteen 
hours  or  even  less.  It  is  probable  that  the  shorter 
periods  mentioned  are  more  nearly  the  normal  and 
that  the  periods  of  twelve  hours  for  appearance  and 
twenty-five  hours  for  disappearance  should  be  re- 
garded as  the  extreme  limits  of  normal  motility. 
The  normal  time  for  the  stomach  to  empty  itself  is 
four  to  five  hours.  At  the  end  of  seven  or  eight 
hours  the  small  intestine  should  be  emptied  and  the 
unutilized  food  residues  should  be  found  wholly  in 
the  colon.  These  residues  normally  find  their  way 
to  the  rectum  in  three  or  four  hours  more,  and  there 
seems  to  be  no  good  reason  why  unusable  and  pu- 
trescible  materials  should  be  retained  for  a  longer 
time  to  undergo  decomposition  and  contaminate  the 
blood  through  the  absorption  of  the  poisonous  prod- 
ucts. 


COLON  CODE  405 

In  barn  yard  fowls  the  length  of  time  required 
for  food  to  traverse  the  entire  alimentary  canal  is 
three  hours  and  a  half.  In  some  animals  the  period 
is  not  more  than  one  hour. 

In  cases  of  chronic  constipation  the  time  for  the 
appearance  and  the  disappearance  of  the  test  color 
is  very  greatly  lengthened.  The  time  of  appearance 
is  not  infrequently  prolonged  to  twenty-four  or 
thirty-six  hours  and  the  time  of  disappearance  is, 
in  a  large  proportion  of  cases,  forty-eight  hours  or 
more.  Seventy-two  hours  or  three  days  is  not  an 
uncommon  observation  and  the  writer  has  observed 
cases  in  which  the  color  did  not  disappear  until  the 
end  of  four  days  and  in  one  case,  six  days.  Cases 
are  occasionally  observed  in  which  the  color  dis- 
appears and  then  reappears.  The  explanation  of 
this  circumstance  is  the  existence  of  a  greatly  dilated 
cecum  in  which  a  portion  of  a  meal  may  be  re- 
tained while  the  residues  of  a  subsequent  meal  pass 
over  and  on  to  exit. 

By  means  of  the  carmine  test  the  degree  of  stasis 
or  stagnation  of  intestinal  contents  may  be  ascer- 
tained and  the  improvement  resulting  from  diet  or 
treatment  may  be  observed.  This  test  is  one  that 
ought  not  to  be  omitted  in  any  case  of  obstinate 
constipation  which  does  not  readily  yield  to  the  meas- 
ures applied  and  it  is  advantageous  in  all  cases. 


Index 

Abdomen,  pain  in 137-139 

relaxed,   and   constipation 84 

weak  contraction   of 156 

compression-breathing  283 

massage  in  treatment  of  constipation 290,  291 

muscles,   to   strengthen 278 

pouring   douche   bath 244,  245 

support  in  spastic  constipation 320 

support  in  treatment  of  constipation 298 

tenderness  of,  resulting  from  constipation 367 

Acids,  laxative  effects 66,     91 

Adhesions,   interference  with  peristalsis 81 

Agar-agar,  how  used 233,  234 

in  mixed  constipation 321 

laxative  properties  of 62 

Alcohol,  constipative  effects  of 130 

Alternate  applications  to  abdomen,  fomentations . . .  246 

Anal  fissure,  resulting  from  constipation 366 

incontinence,  resulting  from  constipation 367 

itching,  resulting  from  constipation 366 

spasm,  resulting  from  constipation _.  366 

Anger,   and  constipation 75,  139 

Appetite  juice,  necessity  of 94,    95 

lack    of 135-137 

Arc  light,  in  spastic  constipation 319 

Arteriosclerosis,   in  constipation 152 

Autointoxication,  intestinal,  cause  of 159 

Bacillus  bifidus 166,  167 

bulgaricus   168-173 

Welch's  54 

Backache,  resulting  from  constipation 350,  351 

Bacteria,   acid   forming 166-173 

changing  intestinal 186 

putrefactive  action  in  colon 53,     55 

putrefactive  effects  of 168,  169 

of   intestine -.  163-173 

406 


INDEX  407 

Baths,  abdominal  pouring  douche 244,  245 

alternate  applications  to  abdomen 246 

cold   douche 243  244 

cold  sitz,  constipative  effects 76 

exercise    ■ 242,  243 

fomentation  to  abdomen 246,  247 

hot  bath  and  hot  douche 248 

hot    sitz 248 

hot  sitz  and  cold  pour 245 

in  latent  constipation 317 

in  spastic  constipation 318 

in  treatment  of  constipation 241-248 

rubbing  cold  sitz  bath 245 

wet  girdle 246,  247 

sedative  sitz  bath 246 

simultaneous  hot  and  cold  douche 244 

Bile,    composition    of 60 

relation  to  constipation 59,    60 

Blood-vessels,  diseases  of 179,  180,  342 

Bowel  habits  of  primitive  tribes. 370-399 

in  Aden    391 

in  Africa 376,   394,  395 

in  China 379,  380,  386,  393,  394 

in  Egypt    385 

in  India 386,  391,  392,  356,  398 

in  Italy  389 

in  Japan  394 

in  Kashmir    387 

in  Korea  377,  378 

in  Mukden    386 

in  New   Hebrides 390 

in  Palestine    385 

in  Persia  383,  384,  394 

in  Smyrna     389 

in  South    Nigeria 395 

in  Syria    375,  376 

in  Turkey 381,   382,  393 

Bowel  kneading  at  stools,  in  treatment  of 

constipation    294 

Bran-fruit   diet 191,  193 

Bran,   how  to   sterilize 237 

how  to  use 236,  240 


408  INDEX 

Bran,    recipes .237-240 

gems,    recipe 240 

bran   and   Granola   mush,    recipe 238 

bran  and  graham  biscuits,  recipe 239 

Breathing  exercise 277 

incorrect    114-117 

Brose    240 

Bulk,  afforded  by  vegetables 90 

influence   on   peristalsis    60-  65 

lack  of 90,  91,  99-101 

Buttermilk,  laxative  effects  of 101,  102 

"Call,"   importance  of 119-124 

Cancer,  of  colon,  from  constipation 153,  349 

Cannon  ball,  in  treatment  of  constipation 295 

Carmine  motility  test 403 

Catarrhal  colitis,   resulting  from  constipation. .  .322-329 
Cecum,  massage  in  treatment  of  constipation.  .291,  292 

Cellulose,  amount  in  various  foods 228-230 

Ceylon  moss,  laxative  properties  of 62 

Chair,  an  unhealthful 115 

Changing  intestinal   flora 186,  194 

Chest   raising   exercise 278 

Clothing,  in  treatment  of  constipation 203 

Coffee,  constipative  effect  of 110 

Cold  douche  and  intestinal  activity 70 

Cold  douche  bath 97-99,  243,  244 

Colic,  resulting  from  constipation 368 

Colitis,  muco-membranou,s,  resulting  from 

constipation    338,  339 

Colitis,  resulting  from  constipation 322-329 

when    observed 200 

treatment  of 330-336 

Colon,  adhesions 81 

atony    136,  137 

code 400-403 

compressing    the 281 

contraction  of 80.   140,  141 

evacuation    of 34-  36 

excitant    influences 58-  72 

function    of 23-  28 

length  in  animals 9 

movements   of 28-  30 

obstruction  of 12-140 


INDEX  409 

Colon,  pelvic  loop 31 

physiology  of 17-36 

position  of 19 

replacing    of 283 

splenic   flexure 146 

usefulness   of 9 

weak  contraction  of 156 

Compression  of  waist 84- 

Concentrated  foods,  constipative  effects  of... 73,  74,    81 

Condiments,    injurious   effects    of 106-108 

Constipation,  abdominal  supporter  in  treatment  of. .  298 

baths  in  treatment  of 241-249 

causes   of 12,  78-87,  134 

cumulative    308-314 

curability  of 203-211 

curable   without   drugs 12 

diet  in. ..... .-. 218,  240,  304-308 

exercise  in  treatment  of 272-290 

influences    which    promote 73-  17 

latent,  treatment  of 315-317 

massage,  in  treatment  of 29^-297 

mechanical  effects  of 150 

treatment  of 201-217 

mixed  cases 320,  321 

reflex    138 

reflex,  treatment  of 318-320 

simple 303-308 

symptoms    in    cumulative 195-197 

symptoms  in  latent 197-199 

symptoms   in  simple 195,  196 

symptoms   in   spastic 200 

spastic,  treatment  of 318-320 

use  of  paraffin  oil 260-271 

Cooked   foods,   excessive  use   of 95-97 

Corset  and  constipation 84 

Cream,  skin 355 

Cumulative  constipation,  treatment  of 308-314 

Deep  breathing  exercises 280 

Defecation,  special  exercises  to  aid 289 

Descending  colon,  contraction  of 81 

Diabetes,   amount   of   water   needed 112 

one  cause  of 330 


410  INDEX 

Diaphragm    exercise 284 

Diaphragm,  weakened 155 

Diathermy,   in  constipation 302 

Diet,    Bran-fruit 191-193 

in  mixed  constipation 321 

special  milk 188-191 

Digestion,   time   table 32 

Digestive  organs,  disorders  of 179 

Diseases   resulting   from  constipation 338-368 

Diverticulitis,   resulting   from   constipation 348 

when    operable 210-211 

Drugs,  constipative  effects  of 131-135 

injury    from 257-260 

useless   12-13 

Dryness  of  diet,  effects  of Ill 

Duodenum,   infection    of 329 

catarrh   of 329 

ulceration  of 329 

Eating   and    constipation 87 

Eating,  laxative  effects  of 67 

Eczema,  resulting  from  constipation 348 

Electricity  and   intestinal   activity 68,    69 

in  treatment  of  constipation 300-302 

Emotions,  depressing,  constipative  effects  of.. 75,  76,  139 

Enema,  in  cumulative  constipation 310-313 

in   latent  constipation 317 

in  spastic  constipation 318,  319 

alum    255 

cold  rectal  douche 256 

cold    water 252,  253 

glycerine 255 

hot    saline 252 

hot  soap 251 

hot   water 251 

how  given 249-251 

oil 253,  254 

paraffin  oil 255 

sugar  and  water 254 

Evacuation,  mechanism  of 34-36,  40-50,  153-158 

Exaggerated  knee-chest  breathing 284 


INDEX  4!  I 

Exercise  and  intestinal  activity 70 

bath    242,  243 

effects    of 117,  118 

program 290 

Exercises,  abdominal  muscles 278,  283 

automatic    300,  301 

Exercises,  breathing 277,  280,  281,  283,  284 

chest  raising 278 

colon    281,  283 

diaphragm    284 

hill   climbing 272 

hips   rolling 285 

horseback    riding 273 

inclined    plane 281,  282 

leg  raising 284 

medicine  ball 273 

posture    274-277 

rocking   279 

rocking    chair 277,  278 

rolling   279 

rowing    273 

running    280 

squatting    280 

static    285,  286 

tennis 273 

tension  287,  288 

trunk  raising 279 

trunk    twisting 285 

work    274 

Exophthalmic  goitre,  resulting  from 

constipation 351,  352 

Eyes,  disorders   of 180,  181 

Fallopius,  quoted 258 

Fasting,   constipative   effects   of 75,  103-106 

Fats,  and  intestinal  activity 66 

Fear,  and  constipation 75,  139 

Fecal  fever,  resulting  from  constipation 359,  360 

tumors,  resulting  from  constipation 340 

Fever,  fecal,  resulting  from  constipation 359,  360 

Fissure,  anal,  resulting  from  constipation 364 

Flatulency,   resulting  from  constipation 360,363 

Fomentation   to   abdomen 247 


412  INDEX 

Food  gates,  location  of 17 

Food,  insufficient  amount  of 99-101 

tube,  structure  of 18 

Foods,  atoxic  and  antitoxic 221-240 

laxative 220,  221 

uncooked 222-226 

Fruit  acids,  laxative  effects  of 66,  74,    91 

regimen     191-194 

Gall-bladder,  diseases  of,  resulting  from  constipation  345 

infection  of 329 

Gases,  and  intestinal  activity 67 

Gas,  formation  in  intestine 175 

Gastric  disorders,  resulting  from  constipation 341 

Generative  organs,  disorders   of,  resulting  from 

constipation 358 

Glycerine,   enema 255 

Goitre,  exophthalmic,  resulting  from  constipation  351,  352 

Gout,  rheumatic,  resulting  from  constipation 353 

Graham  and  bran  biscuits,  recipe  for 239 

Graham  bread,  recipe  for 238 

Granola  and  bran  mush,  recipe  for 238 

Habits,  in  treatment  of  constipation 202,  203 

relation  to  constipation 87 

Headache,  caused  by  constipation 150,  151,  346,  347 

Heart  disorders,  resulting  from  constipation 342 

Heat,   and   intestinal   activity 70 

constipative  effects  of Td 

effects  of 97-99 

Hemorrhoids,  resulting  from  constipation 365 

Hepatic  flexure,  delay  at 145,  146 

Hill    climbing. . . . ; 272 

Hips  rolling 285 

Horseback  riding 273 

Hot  bath  and  hot  douche 248 

drinks,  constipative  effects  of 76,  97,    98 

foods,  constipative  effects  of 97,    98 

sitz  and  cold  pour  bath 245 

sitz   bath 248 

Houston's  valves,  thickening  of 148 

Hygiene,  in  treatment  of  constipation 202,  203 

Iliac  colon,  construction  of *     *^1 


INDEX  413 

Ileocecal  valve,  contraction  of 144,  145 

incompetent 82,  141,  149 

structure  and  function  of 27,  28,  2il-  39 

Incontinence  of  anus 367 

Indians,  Alaska,  diet  of 63 

Hopi,  diet  of 64 

Indians,  Malkelkos 87 

Orinoco,  diet  of 64 

South    American 164 

Insomnia,  resulting  from  constipation 345 

Intestinal   canal,   structure   of 18 

content,  composition   of 53-  56 

content,    consistency    of 26 

flora,  changing  the 186-194 

Intussusception  of  colon 153 

Irregular  meals,  injury  of 108,  109 

Itching  anus,  resulting  from  constipation 366 

skin,  resulting  from  constipation 356 

Isinglass,  Japanese 62 

Japanese  isinglass,  laxative  properties  of 62 

seaweed,  hovi?  used 233,  234 

seaweed,  laxative  properties  of 62 

Joints,  diseases  of 181,  182 

Kidney,  diseases  of,  resulting  from  constipation. 343,  344 

movable,  resulting  from  constipation 344 

Kinks,   cause   of   constipation 148,  149 

resulting    from    constipation 368,  369 

Knee-chest  breathing   exercise 280,  281 

Latent  constipation,  treatment  of 315,  317 

Laxative    foods 220,  221 

Leg  raising  exercise 284 

Liquids,  constipative  effects  of 73 

need    of    in    diet 111-115 

Liver,  aid  to  peristalsis 59-  60 

diseases  of,  resulting  from  constipation....         345 
enlargement,  resulting  from  constipation . . .         339 

how    crippled 161-163 

Locomotor  ataxia,  caused  by  constipation 158 

Massage  and  intestinal  activity 69,  70 

in  cumulative  constipation 314 

in  latent  constipation 317 

in  spastic  constipation 319 


414  INDEX 

Massage,  abdominal 290, 291 

bowel 294 

cannon   ball 295 

cecum    291, 292 

mechanical  293 

pneumatic  compression 297 

Massage,  shot  bag 296 

weighted  compress 295,  296 

Mastication,  excessive 89,  90 

Meals,  number  and  size  of 235, 236 

irregularity    of 108, 109 

regularity  of 211-213 

Meat,  constipative  effects  of 77, 91, 92, 103 

Mechanical  massage,  in  treatment  of 

constipation     293 

Medicine    Ball 273 

Milk,   cause   of   toxemia 160 

constipative   effects    of 92,   93, 101 

Motility    test 403 

Muco-membranous  colitis,  caused  by  consti- 
pation  338,  339 

Muscles,  degeneration  of 181, 182 

Myxedema,  resulting  from  constipation 352,  353 

Mush,   constipative   effects   of 74 

Nerves,   disorders   of 180 

Neuralgia,    caused   by   constipation 150 

Nutrition,    disturbance   of 183 

disturbance  in  infants 347 

Obesity,  amount  of  water  needed 112 

tendency  to   constipation 106 

Obstruction    of    colon 140 

Osteo-arthritis,  resulting  from  constipation 353 

Pain,    constipative    'effects    of 75 

Pancreas,   infection  of 330 

chronic  inflammation   of 330 

Paraffin  oil,  action  of 260-271 

enema     255 

in  cumulative  constipation 314 

Russian    67 

when  used '. 308 

Pelvic  colon,  delay  in 33 

how    filled 31, 43 


INDEX  415 

rectal  junction,  delay  at 147 

Peristalsis,  of  transverse  colon 29 

propulsive    29 

molding    ^ 

reverse    29 

Perspiration,   excitant  of   peristalsis 76 

Photophore,  in  spastic  constipation 319 

use  of,  in  constipation 249 

Pigmentation  of  the  skin,  resulting  from 

constipation   353, 354 

Pituitary  body,  intestinal  stimulus 60 

Pneumatic  compress,  use  of  in  treatment  of 

constipation     . ^ 297 

Posture  and  intestinal  activity 70 

importance    of    correct 114-116 

to  correct  sitting 276, 277 

to  correct  standing 274-276 

Proctitis,  resulting  from  constipation 336-338 

treatment   of 337 

Psoriasis,  resulting  from  constipation 356 

Psychic   influences    and   intestinal   activity 68 

Pylorus,    function    of 28 

Rachitis,  resulting  from  constipation 347 

Raw   foods 222-226 

beneficial   effects   of 95,   97 

Rectal  prolapse,  resulting  from  constipation 366 

Rectum,    structure   and    function 20,   21 

Redundancy,    of   colon 82 

■Rheumatic  gout,  resulting  from  constipation...         353 
Rheumatism,  chronic,  resulting  from  constipation        353 

Rocking  chair  exercises 277,  278 

Rolling  exercise 279 

Rowing  27 

Royal  Society,  discussion  of  toxemia 177-193 

Rubbing,  cold  sitz  bath 245 

Running,  on  all  fours 280 

Russian  paraffin  oil 260-271,  30S 

Sauer-kraut,  used  by  Russians 90 

Sedative  sitz  bath 246 

Senility,  resulting  from  constipation 342,  343 

Shot  bag,  use  of  in  treatment  of  constipation.  296 

Simultaneous  hot  and  cold  douche  bath 244 


¥' 


416  INDEX 

Sinuisoidal  current,  in  cumulative  constipation . .         313 

in  latent  constipation 317 

Sitz  baths,  hot  sitz 248 

hot  sitz  with  cold  pour 244  : 

rubbing   cold    sitz 245 

sedative    sitz 246 

Skin  cream,  recipe ^ 248 

diseases,   resulting-  from  constipation ...  181,  353,  367 

Sleep,  constipative  effects  of 76 

Sleep,  irregularity  of 113 

posture   during 215-217 

results  of  loss  of 214,  215 

Small  intestine,  function  of 27 

infection  of 329 

structure  of 21 

Spasm,  anal,  resulting  from  constipation 367 

Spastic  constipation,  treatment  of 318-320 

when  observed 200 

Special  exercises,  to  aid  defecation 289 

Spleen,  a  stimulant  of  peristalsis 60 

enlargement,   resulting  from  constipation . . .         339 

Splenic  flexure,  delay  at 146 

Squatting  exercise 280 

Static   exercise 285, 286 

Stomach  disorders,  resulting  from  constipation.         341 

Stricture,  need  of   operation 152 

Sugar,   and  intestinal  activity 65 

Surgery,   when  needed 208, 211 

Tea,  constipative  effects   of 74,110 

Tennis 273 

Tension  exercise 287,  288 

Thermaphore,  in  mixed  constipation 321 

use  of  in  constipation 249 

Time  Table,  of  digestion 32 

Tobacco,  constipative  effects  of 129 

Toxemia,    intestinal,    cause   of 159-193 

characteristic   effects   of 175,  176, 178-186 

discussed  in  Royal  Society 177-193 

Transverse  colon,  contraction  of 81 

Trunk  raising 279 

twisting    285 


INDEX  417 

Tuberculosis    of   bowels,    resulting   from 

constipation   349,  350 

Tumors,  fecal,  resulting  from  constipati^,. 340 

Tumor  of  colon 153 

Ulcer,  resulting  from  constipation 366 

Urinary  organs,  disorders  of,  resulting  from 

constipation    358 

Vegetable  acids,  laxative  effects  of 66-  91 

gelatin,  laxative  properties  of 62 

laxative  effects  of 101 

use  by  animals  and  primitives 61-  65 

Vertigo,  resulting  from  constipation 357 

Vibration   and   intestinal   activity 69 

in  cumulative  constipation 314 

in  treatment  of  constipation 293,  294 

Volvulus,  resulting  from  constipation 341 

Weighted  compress,  use  of  in  treatment  of 

constipation  295,  296 

Welch's  bacillus 54 

Wet  girdle  bath 246, 247 

White  bread,  constipative  effects  of 91 

A^Srk    274 


DATE  DUE 

^hH2 

i  \ri^     »  L 

jjl        1      IBt.     »#  *1»^ 

1 

i 

■  J  ^  ..- .. 

mi      i 

i;- 

'  /    1995 

Prinled 
In  USA 

^llirKmS^,P.S'T^  LIBRARIES 


0037561774 


Ve^r^ 


